Current HIV treatment guidelines now recommend initiating antiretroviral treatment (ART) at the time of diagnosis. However, a new study has found that such early ART causes greater bone loss compared with deferring ART.
The study followed 399 participants (195 immediate ART and 204 deferred ART) for an average of 2.2 years. Although the study revealed a negative effect on bone density of immediate ART, the overall benefits of ART for preventing HIV transmission and adverse health outcomes prevail. It will be important to understand the long-term consequences of reductions in bone mineral density associated with ART and whether these reductions continue or stabilise with longer therapy.
"What we found was that starting treatment is also associated with accelerated bone loss of about 2-4%, and the rate of decline then appears to slow after the first 2 years of treatment, compared with HIV positive people who deferred treatment," said Prof. Jennifer Hoy, lead author of the Journal of Bone and Mineral Research study. "We have no cure for HIV, so antiretroviral treatment is for life. An increased rate of bone loss may become important years later, in the setting of increased risk of fragility fracture."