Reduced bone mineral density among HIV infected patients on anti-retroviral therapy in Blantyre, Malawi: Prevalence and associated factors

Abstract

Introduction Use of tenofovir based anti-retroviral therapy (ART) in HIV patients is associated with low bone mineral density (BMD). Low BMD predisposes people living with HIV (PLWHIV) to fractures thereby increasing morbidity and mortality. Since the introduction of tenofovir based ARV regimens in 2011, information on the prevalence of low BMD in PLWHIV and receiving ART is still scarce in Malawi. This study aimed to determine the prevalence and associated factors of low BMD among adults living with HIV and receiving ART in Blantyre, Malawi. Methodology This was a cross sectional study involving 282 HIV-positive adults of whom 102 (36%) were males. The participants aged 18-45 years were recruited from three primary and one tertiary health care facilities. Patients with no other comorbidities or conditions associated with low BMD and on ART >12 months were included. Data on BMD (femoral neck and lumbar spine) were collected using Dual-Energy X-ray Absorptiometry (DEXA). The International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity (PA) levels. Participants' body weight (kg) and height (m) were also measured. Descriptive statistics, Chi-Square test and multivariable logistic regression were used to analyse data. Results Mean age of participants was 37(± 6.4) years, mean duration on ART was 5(± 3.5) years and mean body mass index (BMI) was 23(± 4.5) kg/m 2. Twenty percent (55) had reduced BMD. More males (28%) had reduced BMD than females (14%) (p = 0.04). There was a significant association between lumbar BMD and femoral neck BMD (r = 0.66,p<0.001).

Chinese Herbal Medicine Usage Reduces Overall Mortality in HIV-Infected Patients With Osteoporosis or Fractures

“…The pathological mechanism between HIV and/or ART and bone related abnormalities remain to be elucidated, but are probably due to HIV and ART affecting the interactions between osteoclasts and osteoblasts. Furthermore, the loss of bone mineral density is frequently observed in HIV-infected patients with ART (Duvivier et al, 2009;van Vonderen et al, 2009;Grant et al, 2016;Hoy et al, 2017;Chisati et al, 2020b). HIV-infected patients placed on protease inhibitor (PI) regimens demonstrate bone loss in the spine, while the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) regimen is associated with bone loss at the hip (Hoy et al, 2017).…”

Effects of maximal strength training on bone mineral density in people living with HIV and receiving anti-retroviral therapy: a pilot study

“…The use of antiretroviral therapy (ART) to treat human immunodeficiency virus (HIV) leads to reduced bone mineral density (BMD) [1][2][3]. Low BMD categorised as osteopaenia and osteoporosis may increase the incidence of fractures among people living with HIV (PLWHIV) [4] which may escalate the risk for morbidity and increase mortality.…”

Low bone mineral density in HIV-positive young Italians and migrants

“…BMD was assessed by DXA, using a QDR Discovery Hologic DXA in the femoral neck and DXA in the lumbar spine by total body DXA. For each scan, BMD, Z-scores were recorded as previously reported [ 9 – 11 ]. DXA measurements were performed in the femur (femoral neck and/or total hip) and lumbar spine in each patient.…”

“…We suggest the use of tenofovir alafenamide (TAF) molecule instead of tenofovir to reduce the risk of bone toxicity [35,36]. A recent study enrolled young HIV positive with low BMD showed tenofovir as a key molecule in ARV therapy [11]. TAF is a hepatitis B virus (HBV) nucleotide reverse transcriptase inhibitor for the treatment of chronic HBV infection in adults with compensated liver disease and has been approved by the Food and Drug Administration (FDA) for the treatment of HIV-1 in November 2015.…”

“…Among human immunodeficiency virus (HIV)-related comorbidities, the bone disease has emerged as a significant question in this chronically infected population [3][4][5][6][7][8]. Several studies suggest that fracture rates are higher in communities with HIV than among matched uninfected controls despite anti-retroviral therapy (ART) and gender [9][10][11]. The causes of a low bone mineral density (BMD) could be different in HIV-infected patients by considering the time of HIV infection [12].…”