Question:

I have been infected since 1982. I have been on Crixivan and other antiviral meds since the introduction of this protease inhibitor. I was diagnosed with osteopenia 6 years ago. I have read that the length of infection might result in loss of bone density problems, as well as the use of protease inhibitors. If the evlidence is still out on the contributing cause of bone loss in HIV infection, is there any one group of anitvirals that show less bone mineral loss then other antiviral meds? Do those on Crixivan show more bone loss then those on other inhibitors?
Thank you.

Answer provided by:

Marty Markowitz, M. D.
Clinical Director
Staff Investigator, Aaron Diamond AIDS Research Center
Associate Professor, Rockefeller University

Osteopenia is associated with HIV infection.

It has also been reported in patients on HAART-including treatement with protease inhibitors including Crixivan.

It remains unknown whether there are specific drugs that cause osteopenia.

Monkeys given very high doses of tenofovir have shown reduced bone density however clinical trial have not confirmed this association.

Ritonavir has demonstrated effects on bone cells in the test tube that may be related to reduced bone density however there is no unique clinical association demonstrated to date.

A large study of patients with HIV infection showed that their bone density was lower than age matched non HIV infected people independent of treatment status or treatment regimen.

Taken together, you are correct, there is a clear association of bone density loss with HIV infection BUT not with any specific drug or drugs.

I would encourage you to have a frank discussion with your doctor. If you think that Crixivan may be contributing to this ask your physician if you have alternatives....currently there are many alternatives to Crixivan for many HIV infected patients.

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