HIV treatment and bone health
New European research suggests that treatment with tenofovir (Viread, also in the combination pills Truvada and Atripla) results in more bone loss than therapy with abacavir (Ziagen, also in the combination pills Kivexa and Trizivir).
Increasing attention is being paid to bone density in patients with HIV.
The virus itself can cause loss of bone, but there’s now quite a lot of research showing that this can also be a side-effect of HIV treatment.
Reduced bone density can increase the risk of fractures, and European HIV treatment guidelines recommend regular monitoring of bone mineral density.
The latest study compared changes in bone density in two groups of patients during their first year of HIV treatment. Half the patients started therapy with a combination that included tenofovir, the other half with one that included abacavir.
Bone mineral density declined regardless of which drug was taken. But loss was greater amongst those taking tenofovir.
However, some doctors who commented on the study think that much bigger and longer studies are needed to see if any HIV drug causes long-term bone loss, and what the real-life significance of this may be.
Skeleton key: a guide to HIV-related bone loss is now available on our website (it first appeared in our regular publication HIV Treatment Update).
HIV treatment and resistance
If your viral load rebounds while you are on HIV treatment, resistance to the drugs that you are taking may develop.
This can make HIV harder to treat, so it’s important to identify which drugs are associated with a lower risk of resistance.
A study in people new to treatment compared the risk of developing resistance in people who took FTC (emtricitabine, Emtriva, also in the combination pills Truvada and Atripla) and those who took 3TC (lamivudine, Epivir, also in the combination pills Combivir and Trizivir).
The researchers found that when viral load increased to detectable levels, those taking an HIV treatment combination that included FTC were less likely than those taking a combination including 3TC to develop a key resistance mutation called M184V.
The investigators think that this is because tenofovir is stronger than abacavir.
In addition, treatment with a boosted protease inhibitor was associated with a lower risk of this type of resistance than therapy with an NNRTI (non-nucleoside reverse transcriptase inhibitor).
In the UK, nearly everybody taking HIV treatment has an undetectable viral load. However, these results are still useful because they will help doctors and patients decide which drugs to take.
For more information on resistance, visit our website to read our patient information booklet Adherence & resistance or the Drug resistance chapter of our HIV Treatments Directory. Alternatively contact us to find out about ordering printed copies of these resources.
HIV and women
Researchers have found that women are just as likely as men to benefit from treatment with ritonavir-boosted darunavir (Prezista).
The results of this study are especially important because the study included far more women than men (67 vs 33%). Clinical trials usually involve far more men than women.
All the patients had experience of HIV treatment and had a detectable viral load.
Darunavir/ritonavir was taken in combination with other anti-HIV drugs that were selected after looking at individual patients' treatment histories and resistance profiles.
Women and men were equally likely to achieve an undetectable viral load.
In addition, rates of side-effects were similar.
But women were more likely than men to withdraw from the study (33 vs 23%) for reasons other than increase in viral load.
The researchers therefore suggest that more needs to be done to support women taking HIV treatment.
HIV and lung disease
Researchers have found that people with HIV have an increased risk of developing lung disease that has either infectious or uninfectious causes.
The immune damage that untreated HIV causes means that patients can be vulnerable to a number of serious lung diseases related to infections such as bacterial pneumonia, PCP, and TB.
Rates of these and other HIV-related illnesses have fallen since effective HIV treatment became available.
However, chronic organ disease, which often does not have an infectious cause, is now an increasingly significant cause of illness and death in people with HIV. Some of this disease is related to ageing.
Researchers wanted to see if HIV was still associated with a greater risk of lung disease, including illnesses that don’t have an infectious cause.
The study was very big. It involved over 33,000 patients with HIV, and they were compared to over 66,000 HIV-negative patients.
Those with HIV were much more likely to develop new lung disease. The most common were bacterial pneumonia and chronic obstructive pulmonary disease – the latter does not have an infectious cause.
Lung disease occurred at a younger age in patients with HIV.
A higher CD4 cell count and an undetectable viral load were associated with lower rates of lung disease caused by infections.
In addition, patients who were taking HIV treatment had a reduced risk of developing many lung problems that did not have infectious causes.