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Curr Opin HIV AIDS. 2016 May;11(3):306-25. doi: 10.1097/COH.0000000000000274.

Bone health and HIV in resource-limited settings: a scoping review.

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aMakerere University-Johns Hopkins University (MU-JHU) Research Collaboration bDepartment of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda cSchool of Public Health, University of the Witwatersrand, Johannesburg, South Africa dDivision of Endocrinology and Metabolism, Department of Medicine, and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University eExcellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand fMaternal, Adolescent and Child Health (MatCH) Research, University of the Witwatersrand, Faculty of Health Sciences, Department of Obstetrics and Gynaecology gMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa hDepartment of Medicine, Faculty of Medicine, Chulalongkorn University iHIV-NAT, Thai Red Cross AIDS Research Center, Thai Red Cross Society, Bangkok, Thailand *Flavia Kiweewa Matovu and Lalita Wattanachanya contributed equally to the writing of this article.



Sub-Saharan Africa and other resource-limited settings (RLS) bear the greatest burden of the HIV epidemic globally. Advantageously, the expanding access to antiretroviral therapy (ART) has resulted in increased survival of HIV individuals in the last 2 decades. Data from resource rich settings provide evidence of increased risk of comorbid conditions such as osteoporosis and fragility fractures among HIV-infected populations. We provide the first review of published and presented data synthesizing the current state of knowledge on bone health and HIV in RLS.


With few exceptions, we found a high prevalence of low bone mineral density (BMD) and hypovitaminosis D among HIV-infected populations in both RLS and resource rich settings. Although most recognized risk factors for bone loss are similar across settings, in certain RLS there is a high prevalence of both non-HIV-specific risk factors and HIV-specific risk factors, including advanced HIV disease and widespread use of ART, including tenofovir disoproxil fumarate, a non-BMD sparing ART. Of great concern, we neither found published data on the effect of tenofovir disoproxil fumarate initiation on BMD, nor any data on incidence and prevalence of fractures among HIV-infected populations in RLS.


To date, the prevalence and squeal of metabolic bone diseases in RLS are poorly described. This review highlights important gaps in our knowledge about HIV-associated bone health comorbidities in RLS. This creates an urgent need for targeted research that can inform HIV care and management guidelines in RLS.

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