Jadzic Jelena, Dragovic Gordana, Lukic Relja, Obradovic Bozana, Djuric Marija
Center of Bone Biology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
J Pers Med. 2024 Jul 26;14(8):791. doi: 10.3390/jpm14080791.
Skeletal alterations and their complications can significantly impact the quality of life and overall prognosis of patients living with HIV (PLWHIV). Considering skeletal alterations are often asymptomatic and unapparent during routine clinical evaluation, these conditions are frequently overlooked in the clinical management of PLWHIV. However, since the use of combined antiretroviral therapy (cART) has increased life expectancy in PLWHIV effectively, osteopenia, osteoporosis, and bone fragility are now considered to have a major health impact, with a substantial increase in healthcare costs. This narrative literature review aimed to provide a comprehensive overview of the contemporary literature related to bone changes in PLWHIV, focusing on the importance of taking a multi-scale approach in the assessment of bone hierarchical organization. Even though a low bone mineral density is frequently reported in PLWHIV, numerous ambiguities still remain to be solved. Recent data suggest that assessment of other bone properties (on various levels of the bone structure) could contribute to our understanding of bone fragility determinants in these individuals. Special attention is needed for women living with HIV/AIDS since a postmenopausal status was described as an important factor that contributes to skeletal alterations in this population. Further research on complex etiopathogenetic mechanisms underlying bone alterations in PLWHIV may lead to the development of new therapeutic approaches specifically designed to reduce the health burden associated with skeletal disorders in this population. A major challenge in the clinical management of PLWHIV lies in the adverse skeletal effects of some frequently prescribed cART regimens (e.g., regimens containing tenofovir disoproxil fumarate), which may require a switch to other pharmacological approaches for maintained HIV infection (e.g., regimens containing tenofovir alafenamide). Taken together, the findings are indicative that the HIV/AIDS status should be taken into consideration when designing new guidelines and strategies for individualized prevention, diagnosis, and treatment of increased bone fragility.
骨骼改变及其并发症会显著影响艾滋病毒感染者（PLWHIV）的生活质量和总体预后。鉴于骨骼改变在常规临床评估中通常无症状且不明显，这些情况在PLWHIV的临床管理中常被忽视。然而，由于联合抗逆转录病毒疗法（cART）的使用有效提高了PLWHIV的预期寿命，骨质减少、骨质疏松和骨脆性现在被认为对健康有重大影响，医疗费用大幅增加。本叙述性文献综述旨在全面概述与PLWHIV骨骼变化相关的当代文献，重点关注在评估骨层次结构时采用多尺度方法的重要性。尽管PLWHIV中经常报告骨矿物质密度低，但仍有许多模糊之处有待解决。最近的数据表明，评估其他骨特性（在骨结构的不同层面）可能有助于我们了解这些个体的骨脆性决定因素。感染艾滋病毒/艾滋病的女性需要特别关注，因为绝经后状态被描述为导致该人群骨骼改变的一个重要因素。对PLWHIV骨骼改变潜在的复杂病因机制进行进一步研究，可能会开发出专门设计的新治疗方法，以减轻该人群与骨骼疾病相关的健康负担。PLWHIV临床管理中的一个主要挑战在于一些常用的cART方案（如含有富马酸替诺福韦二吡呋酯的方案）的不良骨骼效应，这可能需要改用其他维持艾滋病毒感染的药理学方法（如含有替诺福韦艾拉酚胺的方案）。综上所述，这些发现表明，在设计针对骨脆性增加的个体化预防、诊断和治疗的新指南和策略时，应考虑艾滋病毒/艾滋病状态。
