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. 2021 Nov 1;35(13):2137-2147.
doi: 10.1097/QAD.0000000000002990.

Persistently lower bone mass and bone turnover among South African children living with well controlled HIV

Yanhan Shen  1 , Stephanie Shiau  2 , Renate Strehlau  3 , Megan Burke  3 , Faeezah Patel  3 , Cara T Johnson  4 , Bridgette Rizkalla  5 , Gallagher Dympna  5   6 , Louise Kuhn  1   7 , Ashraf Coovadia  3 , Michael T Yin  8 , Stephen M Arpadi  1   7   9
Affiliations

Persistently lower bone mass and bone turnover among South African children living with well controlled HIV

Yanhan Shen et al. AIDS. .

Abstract

Objective: We evaluated longitudinal trends and associations between bone mass, bone turnover and inflammatory markers among South African children living with HIV (CLHIV) and controls.

Design: We previously reported decreased bone mass among CLHIV independent of marked inflammation and increased bone turnover. The goal of this study was to evaluate longitudinal changes in bone mass, bone turnover and inflammation over 2 years.

Methods: Longitudinal analyses were conducted among 220 CLHIV and 220 controls. Anthropometric measurements, physical activity, antiretroviral regimen, virologic and immunologic status, whole body (WB) and lumbar spine (LS) bone mineral content (BMC) and bone mineral density (BMD) were collected (enrollment, 12 and 24 months). Bone turnover markers including C-telopeptide of type I collagen (CTx) and procollagen type I N-terminal propeptide (P1NP) and inflammatory markers including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble CD14 and high-sensitivity C-reactive protein (hsCRP) were collected at enrollment and 24 months.

Results: Compared with controls, CLHIV had significantly lower mean WB-BMC, WB-BMD, WB-BMC z scores, LS-BMC and LS-BMD as well as lower bone formation (P1NP) and resorption (CTx), and higher hsCRP and soluble CD14 over 24 months. CLHIV on efavirenz (EFV) had consistently lower TNF-alpha and IL-6 compared with those on ritonavir-boosted lopinavir (LPV/r) at all time points.

Conclusion: Over 2 years of follow-up, South African CLHIV had persistently lower bone mass, bone turnover, and macrophage activation. Lower bone mass and higher pro-inflammatory cytokine profiles were consistently observed among those on LPV/r-based compared with EFV-based regimens.

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Figures

Figure 1:
Figure 1:. WB and LS BMC, BMC Z score and BMD stratified by HIV status at enrollment, 12- and 24-month visits:
Abbreviations: Whole Body (WB); Lumbar Spine (LS); Bone mineral content (BMC); Bone mineral density (BMD); Children living with HIV (CLHIV)
See this image and copyright information in PMC

Comment in

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