Fosamax for HIV-Related Bone Problems

People with HIV/AIDS (PHAs) who use corticosteroids and/or anti-HIV therapy may be at increased risk for the development of thinner, more porous bones -- a condition called osteoporosis. As bones become thinner they can easily break or fracture. The best course of action to prevent and treat osteoporosis in PHAs is not yet clear and researchers are experimenting with different strategies. In a letter to be published in the August 1, 2001 issue of the journal Clinical Infectious Diseases, researchers in Italy reported that the bone-building treatment Fosamax (alendronate) has helped one PHA recover from osteoporosis. We now report the details of their report.

According to the team, the 51-year-old PHA had been on a highly active antiretroviral therapy (HAART) regimen consisting of indinavir (Crixivan), 3TC (lamivudine) and d4T (Stavudine) for three years. His CD4+ count was 522 cells and his viral load was less than 50 copies. While walking one day, he hurt his back; X-rays of his spine revealed a fracture in one of his back bones. This damage grew worse after a short period of time, and eventually part of his back bone began to collapse, causing severe disability and pain. Doctors prescribed the following regimen, in addition to his existing HAART regimen, to help rebuild his bones:

• Fosamax, 10 mg/day
• calcium carbonate, 500 mg/day
• vitamin D, 450 international units (IU)/day

Before the PHA began this treatment, bone scans found that he had severe osteoporosis in his spine. After six months of treatment, the thickness of his bones increased by about 20% and he said that his pain was "almost completely relieved." Also after six months the PHA developed high levels of lactic acid in his blood -- a side effect of anti-HIV therapy. As a result, he had to stop taking all his medications, including nutrients.

The Italian researchers noted that doctors in Australia have recently linked the development of high levels of lactic acid to thinning bones in PHAs. As well, the Italian researchers hope that their favourable report about Fosamax encourages other teams to study the safety and effectiveness of this drug in people using HAART.

For background information on bone health and lactic acidosis see CATIE's Treatment Update 117 available at: http://www.catie.ca/tu.nsf.

References

1. Guaraldi G, Ventura P, Albuzza M, et al. Alendronate treatment for osteoporosis in patients infected with Human Immunodeficiency Virus. Clinical Infectious Diseases 2001;33:414-415.