Increased life expectancy and the need for long-term antiretroviral therapy have brought new challenges to the clinical management of HIV-infected individuals. The prevalence of osteoporosis and fractures is increased in HIV-infected patients; thus optimal strategies for risk management and treatment in this group of patients need to be defined. Prevention of bone loss is an important component of HIV care as the HIV population grows older. Understanding the mechanisms by which HIV infection affects bone biology leading to osteoporosis is crucial to delineate potential adjuvant treatments. This review focuses on HIV-induced osteoporosis within the context of microRNAs (miRNAs) by reviewing first basic concepts of bone biology as well as current knowledge of the role of miRNAs in bone development. Evidence that HIV-associated osteoporosis is in part independent of therapies employed to treat HIV (HAART) is supported by cross-sectional and longitudinal studies and is the focus of this review. 1. Introduction The emergence of human immunodeficiency virus (HIV) disease was initially reported in 1981 followed by the identification of the HIV as the cause of the disease in 1983. HIV is a global pandemic that has become the leading infectious disease killer of adults worldwide. In 2006, more than 65 million people had been infected with HIV worldwide and 25 million had died of HIV. In 2007, it was estimated that 33 million people were living with HIV with 2.7 million new infections and 2 million deaths each year. This has caused tremendous socioeconomic damage worldwide. In the USA, this condition afflicts the African American population in a disproportionate fashion although all racial and ethnic groups are afflicted [1]. There are new modalities of treatment including bone marrow transplantation [2], the “Berlin Patient” receiving transplantation with cells conferring HIV resistance [3], and members of the Visconti cohort who seem to be free of HIV infection after stopping antiretroviral therapy [4]. However, all of the above-mentioned modalities of treatment are raising complex ethical issues [5], and it will take years before being fully implemented if approved. Among individuals living with HIV, the proportion of deaths attributed to chronic noninfectious comorbid diseases has increased over the past 15 years. This is partly a result of increased longevity in the area of highly active antiretroviral therapy (HAART) and also because HIV infection is related, causally or otherwise, to several chronic conditions. These comorbidities include conditions that
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