Decreased Vigorous Physical Activity in School-Aged Children with Human Immunodeficiency Virus in Johannesburg, South Africa

Wong, Marcia; Shiau, Stephanie; Yin, Michael T.; Strehlau, Renate; Patel, Faeezah; Coovadia, Ashraf; Micklesfield, Lisa K.; Kuhn, Louise; Arpadi, Stephen M.

doi:10.1016/j.jpeds.2016.01.034

Cited by 21 publications

(25 citation statements)

References 27 publications

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“…The number of minutes of vigorous physical activity per week was calculated as previously described and the proportion of children meeting World Health Organization recommendations for physical activity was determined [42, 43]. Dietary intake was collected by an interviewer-administered 24 hour recall of the previous day’s intake.…”

Section: Methodsmentioning

confidence: 99%

Efavirenz is associated with higher bone mass in South African children with HIV

Arpadi

Shiau

Strehlau

et al. 2016

Aids

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Background We investigate if switching from a ritonavir-boosted lopinavir (LPV/r)-based to an efavirenz-based antiretroviral therapy (ART) regimen is associated with beneficial bone development. Methods The CHANGES Bone Study follows HIV-infected children who participated in a non-inferiority randomized trial in Johannesburg, South Africa evaluating the safety and efficacy of pre-emptive switching to efavirenz (N=106) compared to remaining on LPV/r (N=113). HIV-uninfected children were also recruited. Whole body (WB) and lumbar spine bone mineral content (BMC) were assessed by dual-energy X-ray absorptiometry (DXA) at a cross-sectional visit. BMC Z-scores adjusted for sex, age, and height were generated. Physical activity (PA) and dietary intake were assessed. CD4 percentage and viral load were measured. We compared bone indices of HIV-infected to HIV-uninfected children and LPV/r to efavirenz by intent-to-treat. Results The 219 HIV-infected (52% male) and 219 HIV-uninfected (55% male) children were 6.4 and 7.0 years of age, respectively. Mean ART duration for HIV-infected children was 5.7 years. WB BMC Z-score was 0.17 lower for HIV-infected children compared to HIV-uninfected children after adjustment for PA, dietary vitamin D and calcium (p=0.03). WB BMC Z-score was 0.55 higher for HIV-infected children switched to efavirenz compared to those remaining on LPV/r after adjustment for PA, dietary vitamin D and calcium, CD4 percentage and viral load (p<0.0001). Conclusion South African HIV-infected children receiving ART have lower bone mass compared to HIV-uninfected controls. Accrued bone mass is positively associated with switching to efavirenz-based ART compared to remaining on LPV/r, providing additional rationale for limiting LPV/r exposure once viral suppression has been achieved.

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Section: Methodsmentioning

confidence: 99%

Efavirenz is associated with higher bone mass in South African children with HIV

Arpadi

Shiau

Strehlau

et al. 2016

Aids

Self Cite

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“…Muscle strength and bone strength are closely related; muscles exert forces on bone resulting in bone adaptation in size and strength [11]. HIV infection and consequent ill-health may result in reduced physical activity, which in turn may impair muscle strength and skeletal impact loading, impairing bone development [[12], [13], [14]]. Furthermore, ART may itself adversely affect bone and muscle health [15,16].…”

Section: Introductionmentioning

confidence: 99%

Older age at initiation of antiretroviral therapy predicts low bone mineral density in children with perinatally-infected HIV in Zimbabwe

Gregson

Hartley

Majonga

et al. 2019

Bone

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Background Perinatally-acquired HIV infection commonly causes stunting in children; how this affects bone and muscle development is unclear. We investigated differences in bone and muscle mass and muscle function between children with HIV (CWH) and uninfected children. Setting Cross-sectional study of CWH (6–16 years) receiving antiretroviral therapy (ART) for >6 months and similar aged children testing HIV-negative at primary health clinics in Zimbabwe. Methods From Dual-energy X-ray Absorptiometry (DXA) we calculated total-body less-head (TBLH) Bone Mineral Content (BMC) for lean mass adjusted-for-height (TBLH-BMC LBM ) Z-scores, and lumbar spine (LS) Bone Mineral Apparent Density (BMAD) Z-scores. Results The 97 CWH were older (mean age 12.7 vs. 10.0 years) and taller (mean height 142 cm vs. 134 cm) than 77 uninfected. However, stunting (height-for-age Z-score ≤ −2) was more prevalent in CWH (35% vs. 5%, p < 0.001). Among CWH, 15% had low LS-BMAD (Z-score ≤ −2) and 13% low TBLH-BMC LBM , vs. 1% and 3% respectively in those uninfected (both p ≤ 0.02). After age, sex, height and puberty adjustment, LS-BMAD was 0.33 SDs (95%CI -0.01, 0.67; p = 0.06) lower in CWH, with no differences by HIV status in TBLH-BMC LBM , lean mass (0.11 [−0.03, 0.24], p = 0.11) or grip strength (0.05 [−0.16, 0.27], p = 0.62). However, age at ART initiation was correlated with both LS-BMAD Z-score (r = −0.33, p = 0.001) and TBLH-BMC LBM Z-score (r = −0.23, p = 0.027); for each year ART initiation was delayed a 0.13 SD reduction in LS-BMAD was seen. Conclusion Size-adjusted low bone density is common in CWH. Delay in initiating ART adversely affects bone density. Findings support immediate ART initiation at HIV diagnosis.

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“…Muscle strength and bone strength are closely related; muscles exert forces on bone resulting in bone adaptation in size and strength 11 . HIV infection and consequent ill-health may result in reduced physical activity, which in turn may impair muscle strength and skeletal impact loading, impairing bone development 12–14 . Furthermore, ART may itself adversely affect bone and muscle health 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Older age at Initiation of Antiretroviral Therapy Predicts Low Bone Mineral Density in Children with perinatally-infected HIV in Zimbabwe

Gregson

Hartley

Majonga

et al. 2019

Preprint

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BackgroundPerinatally-acquired HIV infection commonly causes stunting in children, but how this affects bone and muscle development is unclear. We investigated differences in bone and muscle mass and muscle function between children with HIV (CWH) and uninfected children.SettingCross-sectional study of CWH (6–16 years) receiving antiretroviral therapy (ART) for >6 months and children in the same age-group testing HIV-negative at primary health clinics in Zimbabwe.MethodsFrom Dual-energy X-ray Absorptiometry (DXA) we calculated total-body less-head (TBLH) Bone Mineral Content (BMC) for lean mass adjusted-for-height (TBLH-BMCLBM) Z-scores, and lumbar spine (LS) Bone Mineral Apparent Density (BMAD) Z-scores.ResultsThe 97 CWH were older (mean age 12.7 vs. 10.0 years) and therefore taller (mean height 142cm vs. 134cm) than those 77 uninfected. However, stunting (height-for-age Z-score≤-2) was more prevalent in CWH (35% vs. 5%, p<0.001). Amongst CWH, 15% had low LS-BMAD (Z-score ≤-2) and 13% had low TBLH-BMCLBM, vs. 1% and 3% respectively in those uninfected (both p≤0.02). After age, sex, height and puberty adjustment, LS-BMAD was 0.33 SDs (95%CI −0.01, 0.67; p=0.06) lower in CWH, with no differences in TBLH-BMCLBM, lean mass or grip strength by HIV status. However, there was a strong relationship between age at ART initiation and both LS-BMAD Z-score (r=-0.33, p=0.001) and TBLH-BMCLBM Z-score (r=-0.23, p=0.027); for each year ART initiation was delayed a 0.13 SD reduction in LS-BMAD was seen.ConclusionSize-adjusted low bone density is common in CWH. Delay in initiating ART adversely affects bone density. Findings support immediate ART initiation at HIV diagnosis.

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Decreased Vigorous Physical Activity in School-Aged Children with Human Immunodeficiency Virus in Johannesburg, South Africa

Cited by 21 publications

References 27 publications

Efavirenz is associated with higher bone mass in South African children with HIV

Efavirenz is associated with higher bone mass in South African children with HIV

Older age at initiation of antiretroviral therapy predicts low bone mineral density in children with perinatally-infected HIV in Zimbabwe

Older age at Initiation of Antiretroviral Therapy Predicts Low Bone Mineral Density in Children with perinatally-infected HIV in Zimbabwe

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