The effects of HIV on bone and muscle health through the lifespan in populations living in Africa

Africa is home to the majority of people living with HIV (PWH) worldwide. Improved availability and access to antiretroviral treatment (ART) has increased survival, with the resultant ageing population now facing long-term HIV-associated morbidity, including musculoskeletal conditions. Evidence exists describing the impact of chronic HIV infection and ART on muscle and bone health. Musculoskeletal complications risk injury, disability, pain, high associated health care costs and loss of productivity and quality of life. This review discusses mechanisms by which HIV may affect bone and muscle, including direct cellular stress, indirect chronic inflammation, immunosenescence and hormonal dysregulation, as well as ART-related effects. It appraises evidence for bone and muscle health among PWH across different age groups and populations in Africa. Potential interventions such as improved nutrition, physical activity, vitamin D and calcium supplementation, and use of bisphosphonates to attenuate musculoskeletal morbidity are discussed. Musculoskeletal health services need to be integrated into core HIV-care services. Routine fracture risk assessments and robust preventative management strategies should become the norm, to reduce musculoskeletal morbidity among PWH in Africa.