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Dr. Flavia Matovu Kiweewa, MBChB, MSc, PHD
Role: Lead Researcher in HIV Prevention and Treatment Trials
Expertise: HIV Treatment, Bone Metabolism, Clinical Research
Dr. Kiweewa is a leading researcher in HIV treatment and its long-term complications. Her work focuses on optimizing ART regimens to minimize adverse effects while maintaining virological suppression. She has published extensively on bone health in PLHIV.
Dr. Ali Sheikh, MD
Role: Session Moderator & Clinical Educator
Expertise: HIV Care, Medical Education, Clinical Guideline Implementation
Dr. Sheikh is an experienced clinician and medical educator with extensive experience in HIV care and CME program coordination. He will facilitate the discussion and ensure optimal learning experience for all participants.
Overview
Advances in antiretroviral therapy (ART) have transformed HIV into a manageable chronic condition. As people living with HIV (PLHIV) live longer, long-term complications—particularly bone loss and fractures—have emerged as significant clinical concerns. This CME activity explores the complex relationship between HIV infection, ART, and bone metabolism, and provides practical strategies to optimize bone health in HIV care.
Learning Objectives
By the end of this CME activity, participants will be able to:
- Understand the mechanisms linking HIV infection and bone loss
- Identify ART regimens associated with reduced bone mineral density (BMD)
- Recognize risk factors for osteoporosis in PLHIV
- Apply screening and diagnostic tools for bone health assessment
- Implement evidence-based management strategies to prevent fractures
HIV and Bone Health: Key Concepts
Chronic Inflammation Impact
Chronic HIV infection promotes inflammation and immune activation, accelerating bone resorption and compromising bone integrity over time.
Higher Prevalence of Bone Issues
PLHIV have higher rates of osteopenia and osteoporosis, even prior to ART initiation, highlighting the need for early screening and intervention.
Impact of Antiretroviral Therapy on Bone Density
Tenofovir Disoproxil Fumarate (TDF)
Associated with greater early bone loss, particularly in the first 24-48 weeks of treatment.
Protease Inhibitors (PIs)
May impair vitamin D metabolism and osteoblast function, contributing to decreased bone formation.
Tenofovir Alafenamide (TAF)
Demonstrates a more favorable bone safety profile with less impact on bone mineral density.
Risk Factors for Bone Loss in PLHIV
Screening and Diagnosis
DEXA Scan
Gold standard for measuring Bone Mineral Density (BMD) at the hip and spine.
FRAX Tool
Estimates 10-year probability of major osteoporotic fractures.
Laboratory Tests
Calcium, phosphate, vitamin D, parathyroid hormone (PTH), and bone turnover markers.
Management Strategies
1. Optimize ART Selection
Consider switching from TDF to TAF or other bone-sparing regimens when clinically appropriate, balancing virological efficacy with bone safety.
2. Lifestyle Interventions
Weight-bearing and resistance exercise, smoking cessation, and limiting alcohol consumption to reduce fracture risk.
3. Nutritional Support
Calcium: 1,000–1,200 mg/day
Vitamin D: 800–1,000 IU/day to maintain optimal levels (>30 ng/mL)
4. Pharmacologic Therapy
Bisphosphonates for osteoporosis or high fracture risk
Hormone replacement therapy in selected patients (postmenopausal women, hypogonadal men)
Monitoring and Follow-Up
Repeat DEXA scans every 1–2 years in high-risk patients, with ongoing reassessment of ART regimens and fracture risk factors. Collaborative care between infectious disease specialists, endocrinologists, and nutritionists is essential for comprehensive skeletal health in PLHIV.
Target Audience
Join This Essential CME Activity
Register now to learn practical strategies for managing bone health in people living with HIV. Earn 2.0 AMA PRA Category 1 Credits™ while enhancing your clinical practice.
Register TodayOrganized by: MUJHU Research Collaboration & Merita Health