Is Bone Loss After Initiating ART Mediated by Immune Reconstitution?

After initiation of antiretroviral therapy (ART), bone mineral density (BMD) declines abruptly for 1 to 2 years before stabilizing in most HIV-infected patients. Despite differences in the extent of the decline depending on antiretroviral regimen, some bone loss occurs regardless of regimen, suggesting a common mechanism may be at work in addition to direct drug effects. In animal studies, bone loss has been linked to T-cell reconstitution and inflammation. Now, investigators have explored whether a similar mechanism may be involved in humans.

Twenty HIV-infected patients (80% men, 90% African-American) initiated therapy with tenofovir disoproxil fumarate (TDF)/FTC and ritonavir-boosted lopinavir (the samples were collected some years ago, h…