Bone Complications of HIV

Module 13, Version 4


  • Bolland MJ, Wang TK, Gray A, et al. Stable bone density in HAART-treated individuals with HIV: a meta-analysis. J Clin Endocrinol Metab. 2011;96:2721-2731.
  • Brown TT, McComsey, GA. Osteopenia and osteoporosis in patients with HIV: a review of current concepts. Curr Infec Dis Rep. 2006;8:162-170.
  • Brown TT, Hoy J, Borderi M, et al. Recommendations for evaluation and management of bone disease in HIV. Clin Infect Dis. 2015;60:1242-1251.
  • Brown TT, Moser C, Currier J, et al. Changes in bone mineral density after initiation of antiretroviral treatment with tenofovir disoproxil fumarate/emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir or raltegravir. J Infect Dis. 2015;212:1241-1249.
  • Castillo AB, Tarantal AF, Watnik MR, Martin RB. Tenofovir treatment at 30 mg/kg/day can inhibit cortical bone mineralization in growing rhesus monkeys (Macaca mulatta). J Orthop Res. 2002;20:1185-1189.
  • Conessa-Botella A, Florence E, Lynen L, et al. Decrease of vitamin D concentration in patients with HIV infection on a non nucleoside reverse transcriptase inhibitor-containing regimen. AIDS Res Ther. 2010;7:40.
  • Desquilbet L, Jacobson LP, Fried LP, et al. HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. Journal of Gerontology: MEDICAL SCIENCES. 2007 ;62A:(11)1279-1286.
  • Erlandson KM, Lake JE, Sim M et al. Bone Mineral Density Declines Twice as Quickly Among HIV-Infected Women Compared with Men. JAIDS. March 1, 2018. 77(3):288-294.
  • Fox J, Peters B, Prakash M, et al. Improvement in vitamin D deficiency following antiretroviral regimen change: Results from the MONET trial. AIDS Res Hum Retrovir. 2011:27:29-34.
  • Gaksch M, Jorde R, Grimnes G, et al. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLos ONE. 2017;12: e0170791.
  • Gallant JE, Staszewski S, Pozniak AL, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naïve patients: a 3-year randomized trial. JAMA. 2004;292:191-201.
  • Goh SSL, Lai PSM, Tan ATB, Ponnampalavanar S. Reduced bone mineral density in human immunodeficiency virus-infected individuals: a meta-analysis of its prevalence and risk factors. Osteoporosis Int. 2018 Mar;29(3):595-613. PMID: 29159533
  • Grant PM, Kitch D, McComsey GA, Collier AC, et al. Long-term Bone Mineral Density Changes in Antiretroviral-Treated HIV-Infected Individuals. J Infect Dis. 2016 Aug 15;214(4):607-11. PMID:27330053
  • Grant PM, Kitch D, McComsey GA, et al. Low baseline CD4+ count is associated with greater bone mineral density loss after antiretroviral therapy initiation. Clin Infect Dis. 2013;57:1483-1488.
  • Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV  prevention in men who have sex with men. N Engl J Med. 2010;363:2587-2599.
  • Grigsby IF, Pham L, Mansky LM, et al. Tenofovir-associated bone density loss. Ther Clin Risk Manag. 2010;6:41-47.
  • Gyllensten K, Josephson F, Lidman K, Sääf M. Severe vitamin D deficiency diagnosed after introduction of antiretroviral therapy including efavirenz in a patient living at latitude 59 degrees N. AIDS. 2006;20:1906-1907.
  • Hamzah L, Tiraboschi JM, Iveson H, et al. Effects on vitamin D, bone and the kidney of switching from fixed-dose tenofovir disoproxil fumarate/emtricitabine/efavirenz to darunavir/ritonavir monotherapy: a randomized, controlled trial (MIDAS). Antivir Ther. 2016;21:287-296.
  • Havens PL, Long D, Schuster GU : Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 117 and 109 study teams. Tenofovir disoproxil fumarate appears to disrupt the relationship of vitamin D and parathyroid hormone. Antival Ther. 2018;23(7):623-628..
  • Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. 2013;8:136.
  • Holick MF, Binkley NC, Heike A. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-1930.
  • Hoy JF, Richardson R, Ebeling PR, et al. Zoledronic acid is superior to tenofovir disoproxil fumerate-switching for low bone mineral density in adults with HIV. AIDS. 2018 Sep 10;32(14):1967-1975.
  • Kalayjian RC, Albert JM, Cremers S, et al. Women have enhanced bone loss associated with phosphaturia and CD4+ cell restoration during initial antiretroviral therapy.  AIDS. 2018 Nov 13;32(17):2517-2524.
  • Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24:23.
  • Keily M, Cashman KD. Summary outcomes of the ODIN project on food fortification for Vitamin D Deficiency prevention. Int J of Environ. Res. Public Health. 2018 Oct 24;15(11)
  • Khosla S. Pathogenesis of age-related bone loss in humans. J Gerontol A Biol Med Sci. 2013;68:1226-1235.
  • Kooij KW, Ferdinand WNM, Bisschop PH, et al. Low bone mineral density in patients with well suppressed HIV infection: Association with body weight, smoking and prior advanced HIV disease. J Infect Dis. 2015;211:539-48.
  • Lin, KW. Vitamin D Screening and Supplementation in Primary Care: Time to Curb Our Enthusiasm. Am Fam Physician. 2018 Feb 15;97(4):226-227.
  • Llop M, Sifuentes WA, Bañón S, et al.  Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age. Arch Osteoporos. 2018 May 8;13(1):56. PMID: 29736771
  • Mahy M, Autenrieth CS, Stanecki K, Wynd S. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS. 2014;28 Suppl 4:S453-S459.
  • McComsey GA, Kendall MA, Tebas P, et al. Alendronate with calcium and vitamin D supplementation is safe and effective for treatment of decreased bone mineral density in HIV. AIDS. 2007;21:2473-2482.
  • McComsey G, Lupo S, Parks D, et al. Switch from tenofovir disoproxil fumerate combination to dolutegravir with rilpivirine improves parameters of bone health. AIDS 2018. 32:477-485.
  • McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis. 2010;51:937-946.
  • McComsey GA, Kitch D, Daar ES, et. al. Bone mineral density and fractures in antiretroviral-naïve persons randomized to receive abacavir-lamivudine or tenofovir disoproxil fumarate-emtricitabine along with efavirenz or atazanavir-ritonavir: AIDS Clinical Trials Group A5224s, a substudy of ACTG A5202. J Infect Dis. 2011;203:1791-1801.
  • Mulligan K, Glidden DV, Anderson PL, et al. Effects of emtricitabine/tenofovir on bone mineral density in HIV-negative persons in a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2015;61:572-580.
  • Overton ET, Chan ES, Brown TT, et al. Vitamin D and calcium attenuate bone loss with antiretroviral therapy initiation: a randomized trial. Ann Intern Med. 2015: 162:815-824.
  • Pozniak A, Arribas JR, Gathe J, et al. Switching to tenofovir alafenamide, coformulated with elvitegravir, cobicistat, and emtricitabine, in HIV-infected patients with renal impairment: 48-week results from a single-arm, multicenter, open-label phase 3 Study. J Acquir Immune Defic Syndr. 2016;71:530-537.
  • Premaor MO, Compston JE. The Hidden Burden of Fractures in People Living With HIV. JBMR Plus. 2018 Jun 20;2(5):247-256. PMID: 30283906
  • Qaseem A, Forciea MA, McLean RM, et al. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guidelines Update from the American College of Physicians. Ann Intern Med. 2017; 166(11):818-839.
  • Sax PE, Wohl D, Yin M, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate, coformulated with elvitegravir, cobicistat, and emtricitabine, for initial treatment of HIV-1 infection: two randomised, double-blind, phase 3, non-inferiority trials. Lancet. 2015;385:2606-2615.
  • Schwartz JB, Moore KL, Yin M, et al. Relationship of vitamin D, HIV, HIV treatment, and lipid levels in the Women's Interagency HIV Study of HIV-infected and uninfected women in the United States. J Int Assoc Provid AIDS Care. 2014;13:250-259.
  • Sharma A, Ma Y, Tien PC, et al. HIV Infection Is Associated With Abnormal Bone Microarchitecture: Measurement of Trabecular Bone Score in the Women's Interagency HIV Study. J Acquir Immune Defic Syndr. 2018 Aug 1;78(4):441-449.  PMID: 29940603.
  • Spector SA. Vitamin D and HIV: letting the sun shine in. Top Antivir Med. 2011;19:6-10.
  • Tebas P, Powderly WG, Claxton S, et. al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS. 2000;14:F63-F67.
  • Womack JA, Goulet JL, Gilbert C, et al. Increased risk of fragility fractures among HIV-infected compared to uninfected male veterans. PLoS ONE. 2011;6:e17217.
  • Young B, Dao CN, Buchacz K. Increased rates of bone fracture among HIV-infected persons in the HIV outpatient study (HOPS) compared with the US general population, 2000-2006. Clin Infec Dis. 2011;52:1061-1068.
  • Arribas JR, Thompson M, Sax PE, et al. Significant efficacy and long-term safety difference with TAF-based STR in naïve adults. Program and abstracts of the 2017 Conference on Retroviruses and Opportunistic Infections; February 13-16, 2017; Seattle, Washington. Abstract 453.
  • Brown TT, Yin MT, Gupta S, et al. Switching from TDF to TAF in HIV-infected adults with low BMD: a pooled analysis. Program and abstracts of the 2017 Conference on Retroviruses and Opportunistic Infections; February 13-16, 2017; Seattle, Washington. Abstract 683.
  • Flamm, JA. Efficacy and Safety of Tenofovir Alafenamide vs Tenofovir Disoproxil Fumarate in HIV-infected, Virologically Suppressed Black and Non-Blacks Adults Through Week 96: Subgroup Analysis of a Randomized Switch Study. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA
  • Gallant J. European AIDS Conference. October 25-27, 2017. Milan, Italy. Abstract PS8/2.
  • Hodder S, Squires K, Kityo C, et al. Efficacy & safety of switching to EVG/COBI/FTC/TAF in virologically suppressed women. Program and abstracts of the 2017 Conference on Retroviruses and Opportunistic Infections; February 13-16, 2017; Seattle, Washington. Abstract 443.
  • Hosek S, Rudy B, Landowitz R, et al. An HIV pre-exposure prophylaxis (PrEP) demonstration project and safety study for young men who have sex with men in the United States (ATN 110). Program and abstracts of the 8th IAS Conference on HIV Pathogenesis, Treatment & Prevention; July 19-22, 2015; Vancouver, Canada. Abstract TUAC0204LB.
  • McAllister J, Morris D, Holliday S, Carr A. Substantial loss of bone mineral density in some patients receiving tenofovir-emtricitabine as HIV pre-exposure prophylaxis. Program and abstracts of the 18th International Workshop on Co-morbidities and Adverse Drug Reactions in HIV; September 12-13, 2016; New York, New York. Abstract O02.
  • McComsey G, Gonzalez-Garcia J, Lupo S, et al. Sub-study 202094 of SWORD 1 & 2: switch from TDF containing regimen to DTG+RPV improves bone mineral density and bone turnover markers over 48 weeks. 9th International AIDS Society Conference on HIV Science. Paris, July 23-26, 2017.
  • Mulligan K, Hosek S, Kapogiannis BG, et al. Changes in bone mass after discontinuation of pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine in young men who have sex with men who lost bone while using PrEP: extension phase results of Adolescent Trials Network Protocol 110. Program and abstracts of the 18th International Workshop on Co-morbidities and Adverse Drug Reactions in HIV; September 12-13, 2016; New York, NY. Abstract O01.
  • Orkin C, DeJesus E, Ramgopal M, et al. 48 week results from two studies: switching to RPV/FTC/TAF from EFV/FTC/TDF (Study 1160) or RPV/FTC/TDF (Study 1216). Program and abstracts of the 2016 International Congress of Drug Therapy in HIV Infection; October 23-26, 2016; Glasgow, United Kingdom. Abstract O124.
  • Rashbaum B, McDonald C, Mussini C, et al. Age, gender and race analyses of DRV/c/FTC/TAF in HIV-1 treatment-naïve patients. CROI 2018. March 4-7, 2018. Boston, MA. Abstract 492
  • Ritchie AM, Katzman WB, Ma Y, et al. Hyperkyphosis and aging in the Women's Interagency HIV Study. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 727.

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