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Published on: July 24, 2013
Persistently lower bone mass and bone turnover among South African children living with well controlled HIV
Yanhan Shen1, Stephanie Shiau2, Renate Strehlau3
1Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY.
Insights
South African children living with HIV (CLHIV) consistently showed lower bone mass, bone turnover, and macrophage activation over two years. Efavirenz-based regimens were associated with better bone health and lower inflammation compared to lopinavir/ritonavir.
Area of Science:
- Pediatric Bone Health
- HIV/AIDS Research
- Immunology
Background:
- Children living with HIV (CLHIV) previously showed decreased bone mass, independent of inflammation.
- Longitudinal changes in bone mass, turnover, and inflammation in CLHIV require further investigation.
Purpose of the Study:
- To evaluate longitudinal changes in bone mass, bone turnover, and inflammatory markers over 2 years in South African CLHIV and controls.
- To compare bone health and inflammatory profiles between different antiretroviral therapy regimens.
Main Methods:
- Longitudinal study involving 220 CLHIV and 220 controls over 24 months.
- Collected anthropometric data, physical activity, antiretroviral regimen, virologic/immunologic status, bone mineral content/density (BMC/BMD), bone turnover markers (CTx, P1NP), and inflammatory markers (IL-6, TNF-alpha, sCD14, hsCRP).
Main Results:
- CLHIV had significantly lower bone mass (WB-BMC, WB-BMD, LS-BMC, LS-BMD) and bone turnover (P1NP, CTx) but higher inflammation (hsCRP, sCD14) compared to controls over 24 months.
- CLHIV on efavirenz (EFV) regimens exhibited consistently lower TNF-alpha and IL-6 levels than those on ritonavir-boosted lopinavir (LPV/r).
Conclusions:
- South African CLHIV exhibit persistently lower bone mass, bone turnover, and macrophage activation over 2 years.
- Lower bone mass and higher pro-inflammatory cytokines were consistently observed in patients on LPV/r-based regimens compared to EFV-based regimens.
Objective:
We evaluated longitudinal trends and associations between bone mass, bone turnover and inflammatory markers among South African children living with HIV (CLHIV) and controls.
Design:
We previously reported decreased bone mass among CLHIV independent of marked inflammation and increased bone turnover. The goal of this study was to evaluate longitudinal changes in bone mass, bone turnover and inflammation over 2 years.
Methods:
Longitudinal analyses were conducted among 220 CLHIV and 220 controls. Anthropometric measurements, physical activity, antiretroviral regimen, virologic and immunologic status, whole body (WB) and lumbar spine (LS) bone mineral content (BMC) and bone mineral density (BMD) were collected (enrollment, 12 and 24 months). Bone turnover markers including C-telopeptide of type I collagen (CTx) and procollagen type I N-terminal propeptide (P1NP) and inflammatory markers including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble CD14 and high-sensitivity C-reactive protein (hsCRP) were collected at enrollment and 24 months.
Results:
Compared with controls, CLHIV had significantly lower mean WB-BMC, WB-BMD, WB-BMC z scores, LS-BMC and LS-BMD as well as lower bone formation (P1NP) and resorption (CTx), and higher hsCRP and soluble CD14 over 24 months. CLHIV on efavirenz (EFV) had consistently lower TNF-alpha and IL-6 compared with those on ritonavir-boosted lopinavir (LPV/r) at all time points.
Conclusion:
Over 2 years of follow-up, South African CLHIV had persistently lower bone mass, bone turnover, and macrophage activation. Lower bone mass and higher pro-inflammatory cytokine profiles were consistently observed among those on LPV/r-based compared with EFV-based regimens.
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