Protease inhibitor treatment is associated with a significantly greater incidence of osteoporosis (reduced bone density due to loss of vital mineral components), according to researchers from Washington University, St Louis, Missouri.
Researchers found that 21% of a group of 64 men receiving protease inhibitors, compared with 6% of an age-matched HIV-negative control group had severe osteoporosis. There was no significant relationship between osteoporosis and fat redistribution (Tebas). 50% of the PI group had some evidence of reduced bone mass, compared to 29% of the control group. Although some researchers have speculated that reduced level of the male sex hormone testosterone might be linked to reduced bone mass, the St Louis group found no link.
An Australian group also reported reduced bone mass in 80 patients with lipodystrophy: 28% had some signs of osteoporosis, but the proportion with reduced bone mass did not increase during six months of follow-up, and switching from a PI-containing regimen to a PI-sparing regimen did not improve bone mass (Hoy).
The loss of bone mass was most pronounced in the legs and spine, and Jennifer Hoy of Alfred Hospital, Melbourne, warned that research groups worldwide would need to watch for an increased rate of broken bones in PI recipients.
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References
Tebas P et al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. Abstract 207. Seventh Retroviruses Conference, San Francisco, 2000.
Hoy J et al. Osteopenia in a randomised multicenter study of protease inhibitor substitution in patients with the lipodystrophy syndrome and –well-controlled HIV viremia. Abstract 208. Seventh Retroviruses Conference, San Francisco, 2000.