Bone mineral density changes in breastfeeding women living with HIV on antiretroviral therapy in Eastern and Southern Africa.

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To describe postpartum bone mineral density (BMD) change among breastfeeding African women living with HIV (WLHIV) on life-long antiretroviral therapy (ART). In IMPAACT P1084 s, postpartum BMD declines were greater in WLHIV randomized to ART to prevent breastmilk transmission compared to infant nevirapine prophylaxis). This analysis extends the observation period through entry to a follow-on observational study, PROMOTE. Lumbar spine (LS), total hip (TH) and femoral neck (FN) BMD were assessesd using dual energy x-ray absorptiometry (DXA) at postpartum weeks 1 and 74 in P1084 s, and at PROMOTE entry. Participants were included if DXA data were available from PROMOTE entry and > 1 earlier timepoint. Country-specific Z-scores were created by internal standardization to week 1 values. Linear mixed models, adjusted for country, estimated the annualized rate of change in BMD z-scores between postpartum week 1 and PROMOTE entry. Linear regression assessed the association between maternal characteristics and BMD z-score rate of change. We included BMD data from 519 participants between postpartum week 1 through PROMOTE entry (median (IQR) 4.6 (3.5-5.1) years postpartum). For every 5 years passed, LS BMD Z-scores increased by + 0.250 units, while TH and FN BMD z-scores decreased by -0.173 and -0.141 units, respectively. LS, TH and FN BMD increased between postpartum week 74 and PROMOTE entry, but only LS BMD fully recovered to week 1 values. Given dampened TH and FN BMD recovery post-breastfeeding, longer term monitoring is needed to assess peri-/post-menopausal fracture risk, and interventions to optimize bone health among WLHIV on life-long ART.