Human immunodeficiency virus and bone

With effective antiretroviral therapy (ART), persons living with human immunodeficiency virus (HIV) have life expectancies that are approaching that of the general population, with the main cause of death shifted from opportunistic infections to non-acquired immunodeficiency syndrome (non-AIDS) illnesses related to aging. Osteoporosis and fracture has been increasingly recognized as a HIV-associated morbidity. This chapter provides an overview of the epidemiology, pathogenesis, screening, and management of HIV-associated bone loss and fractures, with an emphasis on the role of ART. As HIV-infected individuals have a high burden of risk factors that may lead to falls including peripheral neuropathy, polypharmacy, symptoms of imbalance, and muscle wasting, a fall risk assessment should be done. For those at risk of falling, referral to physical therapy for strength and balance training and minimization of environmental factors leading to falls are recommended. The care of HIV-infected patients with osteoporosis and fracture presents unique challenges and opportunities for interdisciplinary collaboration and research.