TY - JOUR
T1 - Changes in Bone Mineral Density During and After Lactation in Ugandan Women With HIV on Tenofovir-Based Antiretroviral Therapy
AU - Nabwire, Florence
AU - Prentice, Ann
AU - Hamill, Matthew M.
AU - Fowler, Mary Glenn
AU - Byamugisha, Josaphat
AU - Kekitiinwa, Adeodata
AU - Goldberg, Gail R.
N1 - Funding Information:
This research was jointly funded by the Medical Research Council (MRC; program code U105960371) and the Department for International Development (DFID) under the MRC/DFID Concordat agreement; and the Alborada Trust through The Cambridge in Africa Programme. FN's PhD fees and stipend were funded by the Gates Cambridge Scholarship at the University of Cambridge. We acknowledge all the participants, staff in Uganda (Baylor‐Uganda and MUJHU) for their contribution to the study, and the staff in the NBH and NBA laboratories at EWL for laboratory analysis. We also acknowledge Dr Kate Ward for guidance on grading and analysis of DXA images.
Publisher Copyright:
© 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
PY - 2020/11
Y1 - 2020/11
N2 - Antiretroviral therapy (ART) in people living with human immunodeficiency virus (HIV) is associated with bone loss, but data are limited in lactation, when physiological bone mineral mobilization is occurring. This research charted changes in areal bone mineral density (aBMD) during and after lactation in Ugandan women with HIV (WWH) initiated onto ART in pregnancy, compared to women without HIV (REF). One-hundred WWH on tenofovir-based ART and 100 REF were enrolled in pregnancy. Lumbar spine (LS), total hip (TH), and whole-body-less-head (WBLH) aBMD were measured by dual-energy X-ray absorptiometry (DXA) at 2, 14, and 26 weeks of lactation, and at 3 months postlactation. The primary outcome was the difference between groups in mean percent change in LS aBMD between 2 and 14 weeks. Statistical analysis was performed in hierarchical repeated measures ANOVA models that corrected for multiple testing. Median age was 23.4 (IQR, 21.0 to 26.8) years. WWH had lower body weight. aBMD decreased in both groups during lactation, but WWH had greater decreases at TH (2-to-26 weeks: WWH [n = 63] −5.9% [95% CI, −6.4 to −5.4] versus REF [n = 64] −4.3% [95% CI, −4.8 to −3.8]; group*time point interaction p =.008). Decreases in LS aBMD were similar in WWH and REF (2-to-26 weeks: −2.0% [95% CI, −2.5 to −1.5]), although there was a tendency toward a smaller decrease in WWH between 2 and 14 weeks (WWH [n = 77] −1.8% [95% CI, −2.2 to −1.4] versus REF [n = 69] −2.9% [95% CI, −3.3 to −2.5]; group*time point interaction p =.08). Postlactation, LS aBMD was higher relative to week 2 in both groups. TH and WBLH aBMD did not return to week 2 values in WWH but did in REF (TH postlactation versus week 2: WWH [n = 61] −3.1% [95% CI, −3.6 to −2.6]; REF [n = 29] +0.1% [95% CI, −0.9 to +1.1]). These data show accentuated bone loss during lactation and only partial skeletal recovery by 3 months postlactation in Ugandan WWH on tenofovir-based ART. Studies are ongoing to understand longer-term consequences for bone health.
AB - Antiretroviral therapy (ART) in people living with human immunodeficiency virus (HIV) is associated with bone loss, but data are limited in lactation, when physiological bone mineral mobilization is occurring. This research charted changes in areal bone mineral density (aBMD) during and after lactation in Ugandan women with HIV (WWH) initiated onto ART in pregnancy, compared to women without HIV (REF). One-hundred WWH on tenofovir-based ART and 100 REF were enrolled in pregnancy. Lumbar spine (LS), total hip (TH), and whole-body-less-head (WBLH) aBMD were measured by dual-energy X-ray absorptiometry (DXA) at 2, 14, and 26 weeks of lactation, and at 3 months postlactation. The primary outcome was the difference between groups in mean percent change in LS aBMD between 2 and 14 weeks. Statistical analysis was performed in hierarchical repeated measures ANOVA models that corrected for multiple testing. Median age was 23.4 (IQR, 21.0 to 26.8) years. WWH had lower body weight. aBMD decreased in both groups during lactation, but WWH had greater decreases at TH (2-to-26 weeks: WWH [n = 63] −5.9% [95% CI, −6.4 to −5.4] versus REF [n = 64] −4.3% [95% CI, −4.8 to −3.8]; group*time point interaction p =.008). Decreases in LS aBMD were similar in WWH and REF (2-to-26 weeks: −2.0% [95% CI, −2.5 to −1.5]), although there was a tendency toward a smaller decrease in WWH between 2 and 14 weeks (WWH [n = 77] −1.8% [95% CI, −2.2 to −1.4] versus REF [n = 69] −2.9% [95% CI, −3.3 to −2.5]; group*time point interaction p =.08). Postlactation, LS aBMD was higher relative to week 2 in both groups. TH and WBLH aBMD did not return to week 2 values in WWH but did in REF (TH postlactation versus week 2: WWH [n = 61] −3.1% [95% CI, −3.6 to −2.6]; REF [n = 29] +0.1% [95% CI, −0.9 to +1.1]). These data show accentuated bone loss during lactation and only partial skeletal recovery by 3 months postlactation in Ugandan WWH on tenofovir-based ART. Studies are ongoing to understand longer-term consequences for bone health.
KW - AFRICAN WOMEN
KW - BONE HEALTH
KW - HIV
KW - LACTATION
KW - TENOFOVIR-BASED ANTIRETROVIRAL THERAPY (ART)
UR - http://www.scopus.com/inward/record.url?scp=85089860029&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089860029&partnerID=8YFLogxK
U2 - 10.1002/jbmr.4121
DO - 10.1002/jbmr.4121
M3 - Article
C2 - 32573842
AN - SCOPUS:85089860029
SN - 0884-0431
VL - 35
SP - 2091
EP - 2102
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
IS - 11
ER -