Antiretroviral Therapy, Especially Efavirenz, Is Associated with Low Bone Mineral Density in HIV-Infected South Africans

PLoS One. 2015 Dec 3;10(12):e0144286. doi: 10.1371/journal.pone.0144286. eCollection 2015.

Abstract

Purpose: We determined the prevalence and correlates of low bone mineral density (BMD) in HIV-infected South Africans as there is a paucity of such data from Africa.

Methods: BMD and serum 25-hydroxyvitamin D were measured in HIV-positive participants on antiretroviral therapy (ART) and in those not yet on ART (ART-naïve).

Results: We enrolled 444 participants [median age 35(IQR: 30, 40) years; 77% women]. BMD was low (z score <-2SD) in 17% and 5% of participants at the lumbar spine and total hip, respectively. Total hip [0.909 (SD 0.123) vs 0.956 (SD 0.124) g/cm2, p = 0.0001] and neck of femur BMD [0.796 (SD 0.130) vs 0.844 (SD 0.120) g/cm2, p = 0.0001] were lower in the ART, compared to the ART-naïve group. Vitamin D deficiency was present in 15% of participants and was associated with efavirenz use [adjusted OR 2.04 (95% CI 1.01 to 4.13)]. In a multivariate linear regression, exposure to efavirenz or lopinavir-based ART was associated with lower total hip BMD, whereas higher weight, being male and higher vitamin D concentration were associated with higher total hip BMD (adjusted R2 = 0.28). Age, weight, sex, and the use of efavirenz-based ART were independently associated with lumbar spine BMD (adjusted R2 = 0.13).

Conclusions: Vitamin D status, use of efavirenz or lopinavir/ritonavir, weight, age and sex are significantly associated with lower BMD in this young cohort of HIV-infected South Africans.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Alkynes
  • Anti-Retroviral Agents / pharmacology*
  • Anti-Retroviral Agents / therapeutic use
  • Benzoxazines / pharmacology*
  • Benzoxazines / therapeutic use
  • Bone Density / drug effects*
  • Cross-Sectional Studies
  • Cyclopropanes
  • Female
  • Femur / diagnostic imaging
  • HIV Infections / diagnostic imaging
  • HIV Infections / drug therapy*
  • Humans
  • Lopinavir / pharmacology
  • Lopinavir / therapeutic use
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Radiography
  • Reverse Transcriptase Inhibitors / pharmacology*
  • Reverse Transcriptase Inhibitors / therapeutic use
  • South Africa

Substances

  • Alkynes
  • Anti-Retroviral Agents
  • Benzoxazines
  • Cyclopropanes
  • Reverse Transcriptase Inhibitors
  • Lopinavir
  • efavirenz

Grants and funding

JAD and NSL received grants from the World Diabetes Foundation and the South African Department of Health. GM acknowledges partial support by the National Research Foundation of South Africa. LKM would like to acknowledge funding from the Medical Research Council/Department for International Development (DFID) African Research Leader Scheme.