Sex-specific bone architectural deficits among older adults living with HIV: a cross-sectional study from Zimbabwe

People with HIV (PLWH) are living longer with antiretroviral therapy (ART) but HIV increases the risk of age-associated diseases including osteoporosis. A cross-sectional study of men and women ≥40 years was conducted in Harare, Zimbabwe. Sociodemographic data, HIV status/treatment, and anthropometry were collected. Outcomes were peripheral quantitative computed tomography (pQCT): total volumetric bone mineral density v(BMD), trabecular vBMD, cross-sectional area (CSA), compressive bone strength (BSIc), cortical vBMD, cortical thickness, proximal CSA, and polar stress-strain index (pSSI). Sex-stratified linear regression determined differences by HIV status, minimally adjusted for age and wealth-index (WI), and further adjusted for height and weight. Linear regression adjusted for age and WI assessed associations between HIV- and ART-duration, TDF-use, and viral suppression on bone. 1101 participants (PLWH 20.3%; Male 48.6%), aged mean(SD) 62.4(14.1) years, had pQCT data. HIV-related bone impairments, robust to full adjustment for age, wealth-index, height, and weight were observed. Men with HIV (MLWH) had lower radial total vBMD (-7.1% [-10.9; -3.2]%), trabecular vBMD (-11.3% [-16.9%; -5.6%]), and BSIc (-12.0% [-18.7%; -5.4]%) than HIV-negative men. Trabecular findings were similar in women with HIV (WLWH), plus lower cortical vBMD (-1.4 [-2.3; -0.6]%) and thickness (-7.2 [-11.1; -3.3]% were also seen. Tibial pQCT findings were broadly consistent. In WLWH , years since HIV-diagnosis were associated with lower radius total vBMD (-1.9% per-year [-3.2%; -0.6%]), trabecular vBMD (-4.2% [-6.5%; -2.0%]), BSIc (-3.9% [-6.2%; -1.6%]), cortical vBMD (-0.3% [-0.6%; -0.1%]), and thickness (-1.6% [-2.7%; -0.5%]). In MLWH, years since HIV-diagnosis were associated with smaller proximal tibia CSA (-1.0% [-1.9%; -0.2%]) and TDF-use with lower tibia cortical vBMD (-1.4% [-2.8%; -0.1%]). Older Zimbabwean PLWH have markedly lower trabecular vBMD compared to HIV-negative peers additional cortical compartment impairments were evident in women. These data add to the growing evidence that women with HIV in particular may be at increased risk of age-associated osteoporotic fragility fracture relatively early in their life-course.