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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
Older age at initiation of antiretroviral therapy predicts low bone mineral density in children with perinatally-infected HIV in Zimbabwe
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-BMCLBM) 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-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 by HIV status in TBLH-BMCLBM, 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-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.

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.
8756-3282
96-102
Gregson, Celia L.
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Hartley, April
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Majonga, Edith
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McHugh, Grace
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Crabtree, Nicola
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Rukuni, Ruramayi
c2632960-bd81-4238-b214-a6ec3121f899
Bandason, Tsiti
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Mukwasi, Cynthia
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Ward, Kathryn
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Mujuru, Hilda
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Ferrand, Rashida A.
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Gregson, Celia L.
30fae822-e733-4e67-b11a-e46dfb1b269a
Hartley, April
cfb02c1c-4233-4660-84f8-43a51e8ada9a
Majonga, Edith
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McHugh, Grace
49956d4d-ba9e-4bc8-84cc-07533f766c19
Crabtree, Nicola
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Rukuni, Ruramayi
c2632960-bd81-4238-b214-a6ec3121f899
Bandason, Tsiti
f2776cc2-66da-429f-b3d6-345b11946540
Mukwasi, Cynthia
e316ffad-3945-439b-9a4b-fc80b951072a
Ward, Kathryn
39bd4db1-c948-4e32-930e-7bec8deb54c7
Mujuru, Hilda
91a774c1-d14c-462b-803b-50be5a7476be
Ferrand, Rashida A.
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Gregson, Celia L., Hartley, April, Majonga, Edith, McHugh, Grace, Crabtree, Nicola, Rukuni, Ruramayi, Bandason, Tsiti, Mukwasi, Cynthia, Ward, Kathryn, Mujuru, Hilda and Ferrand, Rashida A. (2019) Older age at initiation of antiretroviral therapy predicts low bone mineral density in children with perinatally-infected HIV in Zimbabwe. Bone, 125, 96-102. (doi:10.1016/j.bone.2019.05.012).

Record type: Article

Abstract

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-BMCLBM) 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-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 by HIV status in TBLH-BMCLBM, 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-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.

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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More information

Accepted/In Press date: 9 May 2019
e-pub ahead of print date: 10 May 2019
Published date: August 2019

Identifiers

Local EPrints ID: 431136
URI: http://eprints.soton.ac.uk/id/eprint/431136
ISSN: 8756-3282
PURE UUID: c3f84a11-ca14-4fbc-8c2c-21f6953e502b
ORCID for Kathryn Ward: ORCID iD orcid.org/0000-0001-7034-6750

Catalogue record

Date deposited: 24 May 2019 16:30
Last modified: 26 Nov 2021 05:14

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Contributors

Author: Celia L. Gregson
Author: April Hartley
Author: Edith Majonga
Author: Grace McHugh
Author: Nicola Crabtree
Author: Ruramayi Rukuni
Author: Tsiti Bandason
Author: Cynthia Mukwasi
Author: Kathryn Ward ORCID iD
Author: Hilda Mujuru
Author: Rashida A. Ferrand

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