Since the earliest years of the epidemic, a cure has been the elusive "holy grail" of HIV/AIDS research. Several false starts and failed attempts gave rise to pessimism, and as efforts focused on improving antiretroviral therapy (ART) and managing its complications, the idea of HIV eradication faded into the background.
As improvements in antiretroviral therapy continue to extend lifespans and enhance quality of life, more people living with HIV are hoping and planning to become parents. Roughly three-quarters of HIV positive people in the United States are of reproductive age, and multiple recent studies have found that an HIV diagnosis does little to dampen the desire to have a child.
Bones are the foundation of our bodies; without healthy bones, we can become vulnerable to poor overall health. People with HIV are susceptible to bone loss, and to a condition called osteoporosis that may lead to fractures. In addition, as people with HIV are living longer due to effective antiretroviral therapy, bone complications may worsen as a result of aging and long-term HIV disease. Aging, antiretroviral drugs, traditional bone loss risk factors, and lifestyle all contribute to bone deterioration in the setting of HIV.
The advent of potent combination antiretroviral therapy (ART) in the 1990s allowed people with HIV to live longer, healthier lives. Current United States treatment guidelines recommend that all HIV positive people start antiretroviral therapy if their CD4 count (a key marker of immune health) drops below 350 cells/mm3, and suggest those with a CD4 count between 350 and 500 cells/mm3 consider starting ART. Despite the lifesaving benefits of ART, many people still struggle with the decision to start taking antiretroviral drugs. For some, the prospect of committing to lifelong therapy is daunting. Others hesitate because medications remind them of their disease. For many, the biggest factor in deciding whether to start ART or change their current regimen is the fear of medication side effects.
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