Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
TREATMENT REVIEW 32 - 33 - Fall/Winter 2000
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's 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, particularly postmenopausal women who are at risk for osteoporosis.
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.
More evidence of bone death in people with HIV was also recently presented by researchers from the US National Institutes of Health. A test called magnetic resonance imaging (MRI) was used to look at the hip bones of 339 people with HIV. The researchers found that 15 (around 4%) of the people had osteonecrosis, which is the technical term for bone death. None of the people had experienced any symptoms like hip pain which is usually associated with this problem.
There are currently no recommendations on how to treat this type of bone damage. Switching anti-HIV drugs may be one strategy. For people with high T-cell counts, an interruption in drug treatment may be possible (see "Taking a Break"). Ongoing studies will hopefully provide clearer answers as to how to avoid this side effect.
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