December 18, 2001
"Meet the Experts" sessions "permit conference attendees to interact directly with two specialists on a topic." Or so says the description in the ICAAC program guide. Sounds like a great idea. However the devil is always in the details. Certainly Drs. Currier and Powderly are experts on this topic. But problems arise: The audience is comprised of non-experts as well as experts. The discussion needs to be focused on the needs of both groups. So results tend to be mixed: The experts may be unsatisfied with too basic a discussion, while non-experts may not be up to a higher level of discussion. The setting needs to be conducive to interaction. Two speakers at a podium in a large room with a large number of attendees may not be able to facilitate much of a discussion. Suggestions from me to the ICAAC organizers: Utilize interactive technology to involve the attendees directly in the presentations, make sure the room is suitable -- today there was but one microphone for the audience and questions could not be heard throughout the room.
The session started with each expert giving a brief overview of their topics: Dr. Currier on lipid and glucose disorders and body habitus changes, Dr. Powderly on lactic acidosis and bone disorders. Dr. Currier attempted to discuss new information; Dr. Powderly gave more of an overview and review.
Osteopenia/osteoporosis (or decreased bone density) seems to be much more common than osteonecrosis. A recent antiretroviral-naive study of tenofovir showed a baseline (prior to any antiretroviral therapy) osteopenia rate of 24 percent and osteoporosis of 2 percent. ART has indeed been shown to accelerate bone metabolism. Up to 50 percent of people on ART have abnormal bone density. But so what? Does it lead to bone fractures? Is it progressive? Is it clinically relevant? Well, we actually don't know yet. It takes years for osteopenia to cause fractures and we do not have that data yet. A study presented today at this meeting looked at the fracture rate in studies submitted to the FDA for new drug registration of antiretrovirals. Over 10,000 patient reports were reviewed. The overall fracture rate was 2 percent, essentially identical to that seen in control populations (without HIV). However, the duration of these studies was approximately one year, not long enough to realistically evaluate the risk of fractures related to reduced bone density. So, more studies of much longer duration are urgently needed.
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