AIDS Update


HIV patients have increased susceptibility to osteoporosis

Following the introduction of HAART (Highly Active Antiretroviral Therapy), the survival and quality of life for people infected with the human immunodeficiency virus (HIV-1) have increased in the resource-rich countries. However, with this improved prognosis an increase in long term negative disorders has been observed, namely osteoporosis (the gradual loss of bone mass).

A recent study in the Spanish review Enfermedades Infecciosas y Microbiología Clínica [Infectious Diseases and Clinical Microbiology] shows the increase in prevalence of this disorder in HIV-1 infected patients. There are multiple reasons that explain the propensity to osteoporosis in those patients who have the virus. Some are related to the HIV-1 infection itself, such as the lymphocyte activity, the release of cytokines that stimulate bone absorption, hypogonadism (a disorder where the reproductive organs do not function), Vitamin D deficit, malnutrition or low level of physical activity. Other reasons depend on the treatment patients receive with corticosteroid and antiretroviral medicines.

According to the authors, “for the moment, it does not seem that osteoporotic fractures represent a significant problem. However, as the patient gets older a reduction in their quality of life may occur.

As far as the principal investigator of the study, José Manuel Olmos, is concerned, “recognition that osteoporosis is one of the late consequences of HIV-1 infection compels us to give an early diagnosis of this disease in these patients, in order to take the necessary preventive and therapeutic measures”.

For this reason the study emphasises the need to take a detailed clinical history from HIV-1 infected people, and this should include the classic risk factors for osteoporosis, paying particular attention to treatment that has been received (corticosteriod medicines, HAART, etc) and the pattern of the disease.

Treatment

There is also a scientific consensus as to the recommended preventive measures to take: physical exercise, sufficient ingestion of calcium and Vitamin D, and elimination of risk factors such as alcohol, tobacco and poor diet.

Pharmacological treatment of patients who are diagnosed with osteoporosis is founded usually on the use of bisphosphonates (except in cases where hypogonadism is detected, when it is appropriate to consider suitable hormonal treatment). Bisphosphonates can be administered intermittently, are well tolerated, do not appear to interact with antiretroviral medicines and have proven their use in the prevention and treatment of osteoporosis. However, Olmos asserts that “there is still insufficient experience about the pharmacological treatment of osteoporosis in HIV-1 patients”.

“Despite numerous investigations, results are still awaited from a clinical trial undertaken with a group of seropositive patients treated with Alendronate (Adult AIDS Clinical Trial Group 5163), which, doubtless, will bring new evidence about the possible effectiveness of anti-osteoporotic treatment in these patients,” conclude the authors.

Researchers find new route to fight HIV

Researchers in the US have uncovered a new route for attacking the human immunodeficiency virus (HIV) that may offer a way to circumvent problems with drug resistance. In findings published 28 April 2008 in the online edition of the Proceedings of the National Academy of Sciences, the researchers report that they have blocked HIV infection in the test tube by inactivating a human protein expressed in key immune cells.

Most of the drugs now used to fight HIV, which is the retrovirus that causes acquired immune deficiency syndrome (AIDS), target the virus's own proteins. However, because HIV has a high rate of genetic mutation, those viral targets change quickly and lead to the emergence of drug-resistant viral strains. Doctors have tried to outmaneuver the rapidly mutating virus by prescribing multi-drug regimens or switching drugs. But such strategies can increase the risk of toxic side effects, be difficult for patients to follow and are not always successful. Recently, interest has grown in attacking HIV on a new front by developing drugs that target proteins of human cells, which are far less prone to mutations than are viral proteins.



 Date of upload: 23rd July 2008

                                  
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