Low bone mass in people living with HIV on long-term anti-retroviral therapy: A single center study in Uganda.

Erisa Sabakaki Mwaka,Andrew Kambugu,Arvind Kaimal,Philippa Musoke,Elly Katabira,Barbara Castelnuovo,William Kasozi,Ian Guyton Munabi

doi:10.1371/journal.pone.0246389

Erisa Sabakaki Mwaka, Andrew Kambugu + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0246389

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Journal: PloS one	Publication Date: Feb 5, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: Makerere University, Infectious Diseases Institute

Abstract

This study set out to determine the prevalence of low bone mass following long-term exposure to antiretroviral therapy in Ugandan people living with HIV. A cross-sectional study was conducted among 199 people living with HIV that had been on anti-retroviral therapy for at least 10 years. All participants had dual X-ray absorptiometry to determine their bone mineral density. The data collected included antiretroviral drug history and behavioral risk data Descriptive statistics were used to summarize the data. Inferential statistics were analyzed using multilevel binomial longitudinal Markov chain Monte Carlo mixed multivariate regression modelling using the rstanarm package. One hundred ninety nine adults were enrolled with equal representation of males and females. The mean age was 39.5 (SD 8.5) years. Mean durations on anti-retroviral treatment was 12.1 (SD 1.44) years, CD4 cell count was 563.9 cells/mm3. 178 (89.5%) had viral suppression with <50 viral copies/ml. There were 4 (2.0%) and 36 (18%) participants with low bone mass of the hip and lumbar spine respectively. Each unit increase in body mass index was associated with a significant reduction in the odds for low bone mineral density of the hip and lumbar spine. The duration on and exposure to the various antiretroviral medications had no significant effect on the participant's odds for developing low bone mass. All the coefficients of the variables in a multivariable model for either hip or lumbar spine bone mass were not significant. These results provide additional evidence that patients on long term ART achieve bone mass stabilization. Maintaining adequate body weight is important in maintaining good bone health in people on antiretroviral therapy.

Highlights

Nearly 70% of the people living with the human immunodeficiency virus (HIV), which is an estimated 37.9 million people, are in Sub-Saharan Africa (SSA) [1]
Long-term use of antiretroviral therapy (ART) has been associated with several adverse effects on bone mineral density (BMD) that call for continual monitoring, especially that a sizable proportion of Ugandan people living with HIV (PLWH) have been on ART for long durations
It is important to note that 67% of adults living with HIV are accessing ART in eastern and southern Africa [1] with a sizable proportion of these being on ART for over a decade [6], yet relatively little is known about the impact of ART on bone health

Summary

Introduction

Nearly 70% of the people living with the human immunodeficiency virus (HIV), which is an estimated 37.9 million people, are in Sub-Saharan Africa (SSA) [1]. The burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is higher than the global average; and should be prioritized on the health and development agenda [5]. Non-communicable diseases are becoming a leading cause of morbidity and mortality in the HIV-infected populations especially those on long-term anti-retroviral therapy (ART) [6]. Long-term use of ART has been associated with several adverse effects on bone mineral density (BMD) that call for continual monitoring, especially that a sizable proportion of Ugandan people living with HIV (PLWH) have been on ART for long durations.

Methods

Results

Conclusion