In 2015, 11 out of the 16 million people receiving ART globally were in the WHO Africa region alone . However, unlike RRS where medications such as EFV are no longer preferred, and alternatives to TDF with less bone toxicity are likely to be more frequently used, there are currently no strategies in RLS for minimizing bone loss among HIV-infected individuals. The already limited funding, poor healthcare infrastructures, and sparse personnel pose tremendous challenges toward prevention and management of metabolic bone complications in RLS. As the standard assessment tool for BMD, DXA has only limited value as a single assessment. Serial assessments during HIV patient monitoring while on ART provide more information on the pattern of BMD changes . In RLS, use of DXA scans in assessing BMD is limited by availability, cost, and training. In addition, once the diagnosis is obtained, the current cost of treatment medications for osteoporosis, for example, bisphosphonates is prohibitive. Furthermore, most healthcare personnel in most RLS lack the expertise to make appropriate diagnoses and provide relevant care.
To successfully conduct research addressing the above mentioned gaps in bone health comorbidities in RLS, there is need to work through several existing research networks either regionally or globally. This will ensure effective design and quality implementation approaches are employed. Importantly, involving key policy makers both domestically and regionally upfront will make the future policy implementation more successful.
The review reveals overlapping prevalence of low BMD in RLS and RRS, with a generally higher prevalence of low BMD in RLS overall compared to RRS. We highlight important gaps in our knowledge about HIV-associated bone health comorbidities in RLS. In particular, there are scarce data on bone health mainly from cross-sectional studies that call for urgent need for research that can inform management guidelines in metabolic bone complications in RLS.
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