Abstract
PurposeWe determined the prevalence and correlates of low bone mineral density (BMD) in HIV-infected South Africans as there is a paucity of such data from Africa.MethodsBMD and serum 25-hydroxyvitamin D were measured in HIV-positive participants on antiretroviral therapy (ART) and in those not yet on ART (ART-naïve).ResultsWe enrolled 444 participants [median age 35(IQR: 30, 40) years; 77% women]. BMD was low (z score <-2SD) in 17% and 5% of participants at the lumbar spine and total hip, respectively. Total hip [0.909 (SD 0.123) vs 0.956 (SD 0.124) g/cm2, p = 0.0001] and neck of femur BMD [0.796 (SD 0.130) vs 0.844 (SD 0.120) g/cm2, p = 0.0001] were lower in the ART, compared to the ART-naïve group. Vitamin D deficiency was present in 15% of participants and was associated with efavirenz use [adjusted OR 2.04 (95% CI 1.01 to 4.13)]. In a multivariate linear regression, exposure to efavirenz or lopinavir-based ART was associated with lower total hip BMD, whereas higher weight, being male and higher vitamin D concentration were associated with higher total hip BMD (adjusted R2 = 0.28). Age, weight, sex, and the use of efavirenz-based ART were independently associated with lumbar spine BMD (adjusted R2 = 0.13).ConclusionsVitamin D status, use of efavirenz or lopinavir/ritonavir, weight, age and sex are significantly associated with lower BMD in this young cohort of HIV-infected South Africans.
Highlights
The prevalence of low bone mineral density (BMD) and the risk of associated fractures are higher in HIV-infected patients compared to the general population[1]
In a multivariate linear regression, exposure to efavirenz or lopinavir-based antiretroviral therapy (ART) was associated with lower total hip BMD, whereas higher weight, being male and higher vitamin D concentration were associated with higher total hip BMD
Weight, sex, and the use of efavirenz-based ART were independently associated with lumbar spine BMD
Summary
The prevalence of low bone mineral density (BMD) and the risk of associated fractures are higher in HIV-infected patients compared to the general population[1]. Cumulative use of stavudine which, until recently, was part of first-line ART in resource-limited settings, has been shown to reduce BMD [5, 7]. Tenofovir, which has replaced stavudine in first-line ART WHO recommendations, reduces BMD[8]. The WHO recommended second-line ART regimen includes a ritonavir-boosted protease inhibitor, usually lopinavir, which has been associated with a low BMD and an increased risk of fractures [1, 8]. This risk is likely to increase as the population ages
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