Osteoporosis risk due to HIV gut and HIV drugs (gut-friendly Vit D can help)- Jan 2022

Osteoporosis and HIV Infection

Review Calcif Tissue Int . 2022 Jan 30. doi: 10.1007/s00223-022-00946-4
Emmanuel Biver 1

Life expectancy of people living with HIV (PLWH) is now close to that of the HIV-uninfected population. As a result, age-related comorbidities, including osteoporosis, are increasing in PLWH. This narrative review describes the epidemiology of bone fragility in PLWH, changes of bone features over the course of HIV infection and their determinants, as well as the available evidence regarding the management of osteoporosis in PLWH.
The risk of fracture is higher and increases about 10 years earlier compared to the general population.
The classical risk factors of bone fragility are very widespread and are major determinants of bone health in this population. The majority of bone loss occurs during virus replication and during immune reconstitution at antiretroviral therapies (ART) initiation, which both increase osteoclast activity. Abnormalities in bone formation and mineralization have also been shown in histomorphometric studies in untreated PLWH. Measurement of bone mineral density (BMD) is the first line tool for assessing fracture risk in postmenopausal women, men above 50 years, and other HIV-infected patients with clinical risk factors for osteoporosis. FRAX underestimates fracture probability in PLWH. In case of indication for anti-osteoporotic drug, bisphosphonates remain the reference option. Calcium and vitamin D supplementation should be considered as ART initiation, since it may attenuate bone loss at this stage. Bone-protective ART regimens improve BMD compared to other regimens, but to a lesser extent than bisphosphonate, and without available data on their influence on the incidence of fracture.

Contribution of Gut Microbiome

Another emerging area in the field of HIV and its impact on bone is the contribution of gut microbial dysbiosis, which affects immune function and HIV persistence (Table 2). Chronic HIV infection induces microbial dysbiosis in the gut, resulting in an overall decrease in microbiome diversity and functional capacity. This dysbiosis leads to an increase of the permeability of the gut barrier which adds to the depletion of T-cells induced by HIV in gut-associated lymphoid tissue, and induces an innate immune activation, resulting in a shift toward a pro- inflammatory cytokine environment with osteoclastogen- esis and bone resorption enhancement [56]. In addition to sexual behavior and/or HIV infection, ART also influences the composition of the gut microbiota in PLWH, which changes before and after the start of ART. This has been shown in PLWH and in the context of PrEP and may affect bone health, as demonstrated in the non-HIV population [57-60]. The impact on fecal microbial diversity, which potentially causes intestinal dysbiosis, has been particularly observed in patients receiving ART including nucleotide/nucleoside reverse transcriptase inhibitor (NRTI), with a propensity for intestinal microbiota enriched in Prevotella and poor in Bacteroides [57]. In vitro studies have indicated that zidovudine (AZT), one of NRTI, exhibits antibacterial effects, suggesting potential direct effects on gut microbiota [61]. To what extent targeting gut dysbiosis in ART-stable PLWH could help improve calcium balance and attenuate bone loss remains unexplored.

Gut-friendly Vitamin D is best for health problems with poor guts (HIV, Autism, Diabetes. etc)

Need about 2X less of a gut-friendly form of vitamin D to get the same response

VitaminDWiki - HIV category listing contains:

Pregnant women in HIV therapy adding Vitamin D had 3X fewer deaths - RCT April 2022
HIV treatment augmented by high-dose vitamin D, daily or weekly – Dec 2021
Low vitamin D with HIV increases risk of infections – TB by 3.5X, CMV by 10.1X – Aug 2020
HIV therapy reduces Vitamin D levels, supplementation helps - Nov 2019
Cognitive problems 2X more likely if HIV and low vitamin D – June 2019
Use of Tenofovir disoproxil fumarate (Hepatitis-B, AIDS) requires more vitamin D – Sept 2018
Vertebral fractures 9X more likely in HIV patients having low vitamin D – Dec 2017
HIV patients helped by monthly 120,000 IU of Vitamin D – RCT Oct 2017
Those with HIV who doubled their vitamin D levels reduced their chance of death by 47 percent – Oct 2013
A gut-friendly form of vitamin D should be used for those with HIV and gut problems
   Alternately, just use 2X to 3X more vitamin D than for a person who has a good gut
3X more African girls and women have HIV than African males Washington Post Dec 2023
  Note: Many women have lower vitamin D levels than men due to hormones and not being outdoors as much
  In addition, dark-skinned women often avoid the sun due to a desire to have a lighter skin shade

VitaminDWiki - (Overview Gut and vitamin D contains gut-friendly information