Bone turnover marker trajectories in postpartum women with HIV compared to women without HIV

To compare bone biomarkers in postpartum women with HIV (WWH) and without. We postulated that WWH taking antiretroviral therapy (ART) would not have complete postpartum bone biomarker recovery observed in women without HIV.

Cohort of WWH and age-and-parity-matched women without HIV in Malawi and Uganda, with assessments at entry, delivery, and postpartum/postentry visits (6-weeks, 6-months, 12-months, 24-months and 30/36-months).

We fitted linear mixed-effect models for each biomarker (outcome) and explored biomarker and bone mineral density (BMD) correlations.

Of 312 enrolled participants, 109 (35%) were pregnant without HIV, 104 (33%) pregnant WWH, and 99 (32%) WWH without recent pregnancy. Overall, median (IQR) for age was 33 (30-36) years, and for parity 3 (2-4). For WWH, ART duration was 16 (6-43) months and 185 (91%) were virally suppressed. Bone turnover markers (CTX-1 and P1NP), calcium, phosphorus and 25-hydroxyvitamin D trajectories from delivery through 30-36 months postpartum were similar in WWH and women without HIV, corroborated by adjusted analyses ( P -values >0.05). Compared to WWH without a recent pregnancy, WWH at delivery had significantly higher CTX-1 (0.23 ng/ml), phosphorus (0.31 mg/dl), and 25-hydroxyvitamin D (6.41 ng/ml), while calcium was lower (-0.46 mg/dl), P -value <0.01, respectively, with trajectories converging by 12-24 months postpartum.

Typical postpartum bone chemistry patterns observed in women without HIV were not different in WWH. Additionally, for WWH, postpartum changes normalized by 12-24 months postdelivery. Overall, these findings are reassuring for long-term bone health in reproductive-age African WWH receiving ART.