People living with HIV in Africa are living longer thanks to better medicines, but they’re facing new health challenges as they age. Scientists have discovered that HIV can damage bones and muscles in ways that increase the risk of breaks, pain, and disability. This happens through several pathways: the virus itself causes stress on cells, it triggers long-term inflammation in the body, it ages the immune system faster than normal, and some HIV medicines may have side effects on bone health. The good news is that doctors now understand these problems better and can help prevent them through nutrition, exercise, vitamin D, calcium, and other treatments.

The Quick Take

  • What they studied: How HIV infection and HIV medicines affect bone strength and muscle health in people living across Africa, especially as they get older
  • Who participated: This was a review of existing research, so it looked at findings from many different studies involving people with HIV of various ages across African countries
  • Key finding: HIV can weaken bones and muscles through multiple mechanisms—the virus itself, ongoing inflammation in the body, faster aging of the immune system, and sometimes side effects from HIV medicines—making fractures and muscle loss more common
  • What it means for you: If you or someone you know is living with HIV in Africa, paying attention to bone and muscle health through exercise, good nutrition, and regular check-ups with your doctor may help prevent serious injuries and maintain quality of life as you age

The Research Details

This was a comprehensive review article, meaning researchers looked at all the available scientific evidence about how HIV affects bones and muscles in African populations. Rather than conducting their own experiment, they gathered and analyzed findings from many different studies to understand the bigger picture. This type of research is valuable because it helps identify patterns and trends across multiple studies and populations. The researchers examined how HIV damages bone and muscle through several different biological pathways, looked at how these problems affect people of different ages, and reviewed what treatments and preventive strategies might help.

A review article is important because it brings together scattered research findings into one comprehensive picture. Since Africa has the largest population of people living with HIV worldwide, understanding how the virus affects their bone and muscle health is crucial for public health planning. As HIV medicines have improved and people are living longer, new health problems are emerging that doctors need to understand and address. This review helps healthcare providers in Africa recognize these problems and implement prevention strategies.

This review was published in AIDS, a respected medical journal that focuses on HIV research. The authors examined current scientific evidence on mechanisms of bone and muscle damage, reviewed studies across different African populations and age groups, and discussed both prevention and treatment options. As a review article, its strength comes from synthesizing multiple studies rather than conducting original research. Readers should note that the quality of conclusions depends on the quality of studies reviewed, and some areas may have limited research available.

What the Results Show

The research identified four main ways HIV damages bones and muscles. First, the virus itself causes direct stress on bone and muscle cells, interfering with how they function and repair themselves. Second, HIV triggers chronic inflammation throughout the body—a long-lasting low-level immune response that damages healthy tissue over time. Third, HIV causes the immune system to age faster than normal, a process called immunosenescence, which reduces the body’s ability to maintain strong bones and muscles. Fourth, some antiretroviral medicines (the drugs used to treat HIV) may have side effects that weaken bones, though these medicines are essential for controlling the virus.

The review found that bone loss and muscle weakness are common problems among people living with HIV across Africa, affecting people of all ages but becoming more serious as people get older. Fractures, pain, and reduced mobility are significant concerns that impact daily life and quality of life. The research shows that these musculoskeletal problems increase healthcare costs and can lead to disability if not managed properly.

The authors identified several interventions that may help prevent or slow bone and muscle loss. These include eating a nutritious diet with adequate protein and calories, engaging in regular physical activity including both strength training and weight-bearing exercise, ensuring adequate vitamin D and calcium intake (through food or supplements), and in some cases, using medications called bisphosphonates that help strengthen bones.

The review highlighted that musculoskeletal problems are often overlooked in HIV care, even though they significantly impact quality of life. The research suggests that routine screening for fracture risk should become standard practice in HIV clinics across Africa. The findings also indicate that prevention strategies are more effective and cost-effective than treating problems after they develop. Additionally, the review noted that healthcare systems need to integrate bone and muscle health services into regular HIV care rather than treating them as separate issues.

This review builds on growing evidence that HIV affects multiple body systems beyond the immune system. Previous research established that people with HIV have higher rates of bone loss and fractures, but this comprehensive review clarifies the specific mechanisms and emphasizes the importance of prevention in African populations. The findings align with international guidelines recommending integrated care approaches for people living with HIV, but highlight the specific needs and challenges in African healthcare settings.

As a review article, this research depends on the quality and availability of existing studies. Some aspects of HIV’s effects on bone and muscle health may have limited research, particularly in certain African countries or age groups. The review cannot establish cause-and-effect relationships as definitively as a controlled experiment could. Additionally, healthcare resources and access to interventions vary widely across Africa, so recommendations may not be equally feasible everywhere. The review was published in late 2024, so very recent research developments may not be included.

The Bottom Line

People living with HIV should work with their healthcare providers to: (1) maintain a nutritious diet with adequate protein, calcium, and vitamin D—moderate to high confidence; (2) engage in regular physical activity including strength training—moderate to high confidence; (3) have routine bone health screening and fracture risk assessments—moderate confidence; (4) take calcium and vitamin D supplements if dietary intake is insufficient—moderate confidence; (5) discuss bone health concerns with their HIV doctor, as some medicines may need adjustment—moderate confidence. These recommendations are based on current scientific evidence but should be personalized with your healthcare provider.

This research is most relevant for people living with HIV in Africa, particularly those over age 40 or those who have been living with HIV for many years. Healthcare providers, HIV clinics, and public health officials in Africa should prioritize integrating bone and muscle health screening into routine care. Family members and caregivers of people with HIV should also understand these risks. People living with HIV in other regions may also benefit from these insights, though the review specifically focused on African populations. This research is less directly relevant for people without HIV, though the general principles of bone and muscle health apply to everyone.

Benefits from lifestyle changes like exercise and improved nutrition may begin within weeks to months, with noticeable improvements in strength and energy in 2-3 months of consistent effort. Bone density improvements typically take 6-12 months to become measurable. Fracture risk reduction is a long-term benefit that develops over months to years of consistent prevention strategies. People should not expect immediate results but should view these changes as long-term investments in health and quality of life.

Want to Apply This Research?

  • Track weekly physical activity minutes (target: 150 minutes of moderate activity or 75 minutes of vigorous activity), daily calcium intake in milligrams (target: 1000-1200 mg), vitamin D supplementation or sun exposure, and any bone or muscle pain or concerns on a 1-10 scale
  • Set a weekly reminder to schedule 3-4 exercise sessions that include both weight-bearing activities (walking, dancing, climbing stairs) and strength training (resistance bands, weights, or bodyweight exercises). Log meals to track calcium and protein intake, aiming for 50+ grams of protein daily and 1000-1200 mg of calcium
  • Create a monthly summary view showing trends in exercise consistency, nutritional intake, and any musculoskeletal symptoms. Set quarterly reminders to discuss bone health with your HIV healthcare provider and share app data if helpful for medical decision-making. Track any changes in pain, mobility, or strength over time to identify patterns

This article summarizes research findings and is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. People living with HIV should work with their healthcare providers to develop personalized prevention and treatment plans for bone and muscle health. Do not start, stop, or change any HIV medications or supplements without consulting your doctor. The recommendations in this article should be adapted to your individual health status, local healthcare resources, and personal circumstances. If you experience bone pain, fractures, or significant muscle weakness, seek immediate medical attention.