Need of cost-effectiveness investigation focused on diagnosis, management and prevention of osteopenia and osteoporosis in the setting of HIV disease treated with HAART: when to act, how to act, which patients are the first target of intervention
Abstract number: p1501
Manfredi R., Calza L., Chiodo F.
Osteopenia/osteoporosis are emerging untoward effects of HIV infection/HAART. The pathogenesis is multifactorial, involving all classes of anti-HIV drugs, although protease inhibitor use, overall HAART duration, and the male sex, seem related to a greater risk.
Epidemiological-clinical data. In an ongoing study at our Centre where >1000 HIV-infected patients (p) are followed, bone mineral density was assessed in lumbar spine/femural head by a dual energy X-ray absorptiometry (DEXA) exam to estimate the prevalence of osteopenia/osteoporosis. In a screening of ~100 p, the frequency of osteopenia and osteoporosis (based on lumbar T-score) was ~38% and ~10%, respectively. An increased risk was found in p treated with protease inhibitors versus those receiving non-nucleoside reverse transcriptase inhibitors or triple nucleoside/nucleotide combinations.
Discussion and future insights:
Prospective studies of extensive p samples are needed, to elucidate the epidemiology, pathogenesis, clinical issues and evolution of HIV-associated bone metabolism anomalies. When planning strategies for their early diagnosis, prevention and management also cost-effectiveness issues should be considered, since no pharmacoeconomic data still exist in this setting. Although severe consequences (e.g. pathological fractures, prosthetic implants) are expected to be infrequent their consequences in terms of length and intensity of hospitalization, related costs, and especially severe consequences on the p's quality of life, play a notable role. Anyway, the most reliable diagnostic procedure (DEXA) has affordable costs (around Eur 43.40 for a total-body scan which also offers a body composition assessment), as well as the first-line drugs for osteopenia, e.g. supplementation with calcium (Eur 56.5/month), and vitamin D (Eur 7/month). These costs cannot be compared with the costs of a standard care of an asymptomatic HAART-treated p (Eur 471 to 774/month) and the immunological, virologic, laboratory and clinical controls made at least quarterly. Like postmenopausal osteopenia/osteoporosis (burdened by a greater risk of bone mass anomalies) also HIV disease should be investigated from multiple cost-effectiveness points of view to establish which p are the preferred candidates for a DEXA screening when this examination is more useful during HIV disease course and therapy, when the exam should be repeated and when and how to intervene pharmacologically to prevent serious and potentially invalidating complications.
|Session name:||XXIst ISTH Congress|
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