A Three-Year Follow-Up of Bone Density Among Thai Adolescents With Perinatally Acquired HIV After Completion of Vitamin D and Calcium Supplementation

Abstract

Purpose: To determine changes in bone mineral density (BMD) and bone metabolism-related biomarkers among Thai adolescents with perinatally acquired HIV infection (PHIVA) at 3 years following completion of vitamin D and calcium (VitD/Cal) supplementation.

Methods: An observational follow-up study was conducted among PHIVA who received 48-week VitD/Cal supplementation (either high-dose [3,200 IU/1,200 mg daily] or standard-dose [400 IU/1,200 mg daily]). Lumbar spine BMD (LSBMD) was assessed by dual-energy x-ray absorptiometry. Serum 25-hydroxyvitamin D, intact parathyroid hormone, and bone turnover markers were measured. Changes in LSBMD z-scores and other bone parameters at 3 years after stopping VitD/Cal supplementation compared with baseline or week 48 of supplementation were assessed among participants previously receiving high-dose and standard-dose VitD/Cal supplementation.

Results: Of 114 enrolled PHIVA, 46% and 54% had previously received high-dose and standard-dose VitD/Cal supplementation, respectively. The median age was 20 years; 53% were male. At 3 years after completion of VitD/Cal supplementation, we observed a significant decline in 25-hydroxyvitamin D and increase in intact parathyroid hormone but no significant rebounds of C-terminal telopeptides of collagen type I and procollagen type I amino-terminal propeptides and no significant changes in LSBMD z-scores among PHIVA in both treatment groups, compared with the measurements at week 48 of supplementation. Notably, LSBMD z-scores at 3 years after stopping VitD/Cal supplements were not significantly altered from baseline evaluations in both PHIVA groups.

Discussion: Three years after completion of high-dose or standard-dose VitD/Cal supplementation, LSBMD z-scores of our Thai PHIVA were not significantly changed from baseline and week 48 of supplementation. VitD/Cal supplementation of PHIVA during periods of peak bone mass accrual may have sustained and long-term skeletal benefits.

Keywords: Bone density; Bone health; Bone mass; HIV-infected adolescents; HIV-infected youth; Long-term follow-up; Perinatally acquired HIV infection; Youth living with HIV.

Figure 1.. Change in lumbar spine bone mineral density z-scores of Thai adolescents with perinatally acquired HIV infection from baseline to at 3 years after completion of vitamin D and calcium supplementation, stratified by participant’s previous treatment group.

(A) Overall; (B) By baseline LSBMD. The vertical lines represent the interquartile ranges of LSBMD z-scores for PHIVA at indicated time points. The filled circles and filled triangles represent the outliers of LSBMD z-scores for PHIVA previously receiving high-dose and standard-dose vitamin D and calcium supplementation at indicated time points, respectively. *Indicates the significant change of LSBMD z-score from baseline to at 3 years after completion of vitamin D and calcium supplementation (P < 0.05). Abbreviations: LSBMD, lumbar spine bone mineral density; PHIVA, adolescents with perinatally acquired HIV infection; VitD/Cal, vitamin D and calcium.

Figure 2.. Changes in bone minerals and bone metabolism-related biomarkers of Thai adolescents with perinatally acquired HIV infection from baseline to at 3 years after completion of vitamin D and calcium supplementation, stratified by participant’s previous treatment group.

(A) 25OHD levels; (B) iPTH levels; (C) calcium levels; (D) phosphorus levels; (E) CTX levels; and (F) PINP levels. The vertical lines represent 95% confidence intervals of bone parameters for PHIVA in high-dose and standard-dose VitD/Cal supplementation groups at indicated time point. *Indicates the significant change of each bone parameter from baseline to at 3 years after completion of vitamin D and calcium supplementation (P < 0.05). ^†Indicates the significant change of each bone parameter from week 24 of vitamin D and calcium supplementation to at 3 years after completion of supplementation (P < 0.05). ^‡Indicates the significant change of each bone parameter from week 48 of vitamin D and calcium supplementation to at 3 years after completion of supplementation (P < 0.05). Abbreviations: CTX, C-terminal telopeptide of collagen type I; iPTH, intact parathyroid hormone; PHIVA, adolescents with perinatally acquired HIV infection; PINP, procollagen type I amino-terminal propeptide; VitD/Cal, vitamin D and calcium; 25OHD, 25-hydroxyvitamin D.