Infectious Diseases Unit, Hospital General Universitario, Elche, Spain.
AIDS Rev. 2011 Apr-Jun;13(2):109-18.
Current knowledge suggests that both HIV and antiretroviral drugs are likely to contribute to bone disorders in patients with HIV infection. This article includes a review and update on the part played by the virus and the drugs in the low bone mineral density of HIV-infected patients, and a discussion about their implications in clinical practice. HIV viral proteins may affect osteoblast and osteoclast function, and many clinical studies have shown that during antiretroviral therapy, especially at the beginning, there is an accelerated bone mineral loss associated with bone resorption markers, which may be of differing intensity depending on the HIV drugs used. Vitamin D insufficiency/deficiency is highly prevalent and in some investigations it has been associated with antiretroviral therapy, more often with regimens based on efavirenz. Recent data suggest that immune reconstitution may play a major role in early antiretroviral therapy-related bone loss. Given the complex interaction between HIV and drugs in causing low bone mineral density, optimization of antiretroviral therapy and preemptive strategies aimed to prevent bone loss during therapy may be of paramount importance.
目前的知识表明，HIV 和抗逆转录病毒药物都可能导致 HIV 感染患者的骨骼疾病。本文综述了病毒和药物在 HIV 感染患者低骨密度中的作用，并讨论了它们在临床实践中的意义。HIV 病毒蛋白可能会影响成骨细胞和破骨细胞的功能，许多临床研究表明，在抗逆转录病毒治疗期间，尤其是在开始时，会出现与骨吸收标志物相关的加速骨质流失，其强度可能因所使用的 HIV 药物而异。维生素 D 不足/缺乏非常普遍，在一些研究中，它与抗逆转录病毒治疗有关，更常见于基于依非韦伦的治疗方案。最近的数据表明，免疫重建可能在早期抗逆转录病毒治疗相关的骨质流失中发挥主要作用。鉴于 HIV 和药物在导致低骨密度方面的复杂相互作用，优化抗逆转录病毒治疗和采取预防策略以防止治疗期间的骨质流失可能至关重要。
