The number of HIV-infected patients with ESRD is increasing55. These patients may require treatment with dialysis or renal transplantation, usually in centres with expertise in this area. The one-year survival rate of patients with HIV infection on dialysis has improved recently, although the rate remains inferior to that of the population without HIV infection56. These …
HIV-infected patients are at particular risk of CKD, which is often related to CNICM, such as diabetes and hypertension. Non-infectious comorbidities are increasingly common, with the increased survival and ageing of the HIV-infected patient population. CKD in HIV-infected patients is associated with poorer patient outcomes, including higher morbidity and mortality. CKD is often associated with …
Abraham AG, Althoff KN, Jing Y, et al. End-stage renal disease among HIV-infected adults in North America. Clinical Infectious Diseases 2014;60:941-9. Kalyesubula R, Hau JP, Asiki G, et al. Impaired renal function in a rural Ugandan population cohort. Wellcome Open Research 2018;3. Rosenberg AZ, Naicker S, Winkler CA, Kopp JB. HIV-associated nephropathies: epidemiology, pathology, mechanisms …
David Sowden1. Thomas Hadwen2 Department of Infectious Diseases, Sunshine Coast University Hospital, Queensland. Department of Endocrinology, Sunshine Coast University Hospital, Queensland. Last reviewed: November 2019 Introduction Age-relates co-morbidities, such as osteoporosis, become more important as the HIV population ages. Added to aging, associated co-morbidities, anti-retroviral therapy and the effect of HIV itself contribute to bone …
Definitions Osteoporosis is characterised by low bone mineral density (BMD), and changes in bone architecture, leading to decreased bone strength and an increased fracture risk.1 The World Health Organisation (WHO) has defined osteoporosis on the basis of the T-score.2 Osteoporosis is defined as a T-score of -2.5 or below, osteopaenia as a T-score of between -1.0 and …
It is recommended to assess the risk of fragility fracture and low BMD in all patients with HIV infection.9 Important risk factors for fracture include: Previous history of fragility fracture Glucocorticoid therapy for more than 3 months High risk of falls Those with these risk factors should be assessed with dual-energy X-ray absorptiometry (DXA). In …
Anti-retroviral therapy In those with low BMD or osteoporosis, tenofovir disoproxil fumarate should be avoided.35 A new formulation of tenofovir, tenofovir alafenamide (TAF) is associated with less bone and renal toxicity compared to TDF. In those at high risk of bone toxicity, TDF therapy should be changed to TAF.12,13,35 Studies examining switching from regimens containing …
Osteomalacia is characterised by impaired mineralisation of bone, usually caused by vitamin D deficiency but can also be secondary to several other rarer conditions. It is associated with low BMD, as measured by DXA, and fractures.6 Phosphate wasting caused by the use of TDF may be associated with osteomalacia. The clinical presentation is characterised by …
Also known as avascular necrosis of bone (AVN), this condition results from deficient blood supply to bone resulting in bone death and has been long described in HIV-infected persons.27 Subsequent studies showed that the risk of this condition is increased 100-fold in the HIV-infected population compared to the general population.26 MRI studies have shown that …
HIV-negative persons receiving Pre-Exposure Prophylaxis (PrEP) PrEP is recommended in HIV-negative persons who are at high-risk for HIV infection.13 The recommended regimen for PrEP involves a fixed-dose combination of oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). Given the association of TDF with bone loss, concern exists about bone toxicity in those receiving PrEP. A sub-study from an …