AEGiS-ATDN: Update on Protease Inhibitors and Bone Damage

Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.

Update on Protease Inhibitors and Bone Damage

Information Bulletin #11 June/July 2000

In Information Bulletin #8, we reported on bone damage as a possible side effect of anti-HIV protease inhibitors. More information has now been reported in the scientific journal AIDS. Researchers from St. Louis studied 112 men receiving protease inhibitors. These men had been taking protease inhibitors for an average of two years. The researchers found that half the study participants had decreased bone mineral density. Decreased bone mineral density means that the bones are weaker than they should be. The name for this condition is osteopenia or osteoporosis, depending on the severity of the problem. This may lead to an increased risk of bone fracture. In a comparison group of HIV-positive people not taking protease inhibitors, only 11% (1 in 10) showed evidence of decreased bone mineral density.

The researchers also looked at whether this problem was linked to high blood fats. Many studies have shown that protease inhibitors can increase levels of the blood fats called cholesterol and triglycerides. It is known that high blood fats can cause certain types of bone damage. In this study, osteopenia and osteoporosis appeared to be an independent side effect that was unrelated to changes in blood fats.

The researchers concluded that further studies are urgently needed to find out why this side effect is occurring. Additionally, studies are needed to find out how this problem affects women.

In a separate report at the annual meeting of American Orthopedic Association, Dr Guy Paiement presented information showing an association between protease inhibitors and hip bone death that could potentially lead to arthritis and even the need for hip replacement. The name of the condition is avascular necrosis and Dr Paiement cautioned that doctors need to be aware of this potential protease inhibitor side effect.

The full name of this study is "Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy," by Pablo Tebas and colleagues. The study was published in the journal AIDS, 2000, 14:F63-F67. A news story from Reuters Health about Dr. Guy Paiement's presentation can be found on the JAMA website at http://www.ama-assn.org/special/hiv/newsline/reuters/06198185.htm
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