156 HIV and metabolic disease: Clues to control of HIV infection from the immune and virological response to high dose Vitamin D challenge

Effective use of HAART markedly reduces morbidity and mortality due to classical HIV disease. The 4 key emerging diseases in people with HIV that are amenable to prevention & therapy are Coronary Heart Disease, Renal Disease, Fragility Fractures, Diabetes. These constitute an increasing burden of morbidity and mortality in HIV uninfected people due to an aging population and are becoming even more prevalent in people with chronic HIV. The issue is exemplified by fragility fractures, a major cause of mortality in the elderly, and emerging as a manifestation occurring earlier in people with HIV, and increasing in incidence. The Probono Study from Kings College London demonstrated among 222 patients with matched controls that reported fractures at any site during adulthood occurred more frequently in HIV than controls, 45 (20.3%) vs. 16 (7.2%) (OR = 3.27; P = 0.0001). Osteoporosis was more prevalent in HIV (17.6% vs. 3.6%, P < 0.0001). In HIV, use of highly active antiretroviral therapy (HAART), low body mass and serum PTH were significantly related to low BMD in multivariate analysis. The changing patterns of morbidity and mortality in HIV, driven by the metabolic consequences of HIV infection itself, and the HAART therapy requires development of an appropriate screening and management response.