Bone mineral density among children living with HIV failing first-line anti-retroviral therapy in Uganda: A sub-study of the CHAPAS-4 trial

Abstract

Background Children living with perinatally acquired HIV (CLWH) survive into adulthood on antiretroviral therapy (ART). HIV, ART, and malnutrition can all lead to low bone mineral density (BMD). Few studies have described bone health among CLWH in Sub-Saharan Africa. We determined the prevalence and factors associated with low BMD among CLWH switching to second-line ART in the CHAPAS-4 trial (ISRCTN22964075) in Uganda. Methods BMD was determined using dual-energy X-ray Absorptiometry (DXA). BMD Z-scores were adjusted for age, sex, height and race. Demographic characteristics were summarized using median interquartile range (IQR) for continuous variables and proportions for categorical variables. Logistic regression was used to determine the associations between each variable and low BMD. Results A total of 159 children were enrolled (50% male) with median age (IQR) 10 (7–12) years, median duration of first -line ART 5.2(3.3–6.8) years; CD4 count 774 (528–1083) cells/mm3, weight—for–age Z-score -1.36 (-2.19, -0.65) and body mass index Z-score (BMIZ) -1.31 (-2.06, -0.6). Low (Z-score≤ -2) total body less head (TBLH) BMD was observed in 28 (18%) children, 21(13%) had low lumbar spine (LS) BMD, and15 (9%) had both. Low TBLH BMD was associated with increasing age (adjusted odds ratio [aOR] 1.37; 95% CI: 1.13–1.65, p = 0.001), female sex (aOR: 3.8; 95% CL: 1.31–10.81, p = 0.014), low BMI (aOR 0.36:95% CI: 0.21–0.61, p<0.001), and first-line zidovudine exposure (aOR: 3.68; 95% CI: 1.25–10.8, p = 0.018). CD4 count, viral load and first- line ART duration were not associated with TBLH BMD. Low LS BMD was associated with increasing age (aOR 1.42; 95% CI: 1.16–1.74, p = 0.001) and female sex: (aOR 3.41; 95% CI: 1.18–9.8, p = 0.023). Conclusion Nearly 20% CLWH failing first-line ART had low BMD which was associated with female sex, older age, first-line ZDV exposure, and low BMI. Prevention, monitoring, and implications following transition to adult care should be prioritized to identify poor bone health in HIV+adolescents entering adulthood.

Health-Related Physical Fitness Evaluation in HIV-Diagnosed Children and Adolescents: A Scoping Review

“…The relationship between body composition and the HIV infection/ART use has been the studies main focus, since the beginning of the health-related physical fitness components investigation in HIV-diagnosed children and adolescents, primarily to understand alterations in growth pattern and nutritional status [7][8][9][10][11][12][13][14][15][16][17] and most recently to investigate modifications in body composition such as changes in fat mass distribution [18], alterations in bone mass [19,20] and reduction in muscle mass [21]. In the early 2000s, research began on the cardiorespiratory fitness [22,23], followed by the beginning of the research into muscular strength/endurance in the mid-2000s [27,28] and the beginning of the research into flexibility in 2010 [28], with the aim to investigate the relationship between the HIV infection/ART use and reduce cardiorespiratory fitness [22,23], low muscular strength/endurance [27,28] and flexibility [28].…”

“…Observing the aim of the studies, the results of the present scoping review reflect a broad descriptive investigation of differences between HIV-diagnosed populations and HIV non diagnosed peers [11,19,21,[23][24][25][26]29,30,38,51,73,, prevalences related to health-related physical fitness components [12,[117][118][119][120][121][122][123][124] and different associations [7,8,10,14,15,18,20,22,27,31,33,36,37,[39][40][41][42][43]45,47, between health-related physical fitness components and variables such as the HIV infection status (viral load, CD4 and CD8 lymphocyte count and immunosuppression status) [8,45,134,150] and use of different ART regimens [19,…”

“…The investigation of health-related physical fitness in children and adolescents has been widely used to identify and understand those possible adverse effects of HIV infection/ART use such as changes in body composition (alterations in body fat distribution, reduction in bone mineral content and fat-free mass) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]; reduced cardiorespiratory fitness [22][23][24][25][26]; reduced muscular strength/endurance [26][27][28][29][30]; and reduced flexibility [24,26,31]. However, studies that investigated HIV-diagnosed children and adolescents ended up developing their own methods/protocols for evaluating the health-related physical fitness [32][33][34][35] and also used empirical cut-points for physical fitness tests to classify the participants [19,[36][37][38][39][40][41][42].…”