Bone health in a U.K. cohort of youth living with perinatally acquired HIV-1: a longitudinal study
Author(s)
Type
Journal Article
Abstract
INTRODUCTION: Low bone mineral density (BMD) has been described in children and young people with perinatally acquired HIV (PHIV), which may be related to both traditional (e.g. low body mass index and malnutrition) and HIV-related risk factors (e.g. longstanding exposure to HIV and antiretroviral therapy [ART], with immune suppression, chronic immune activation and inflammation). Here, we evaluate BMD in a U.K. cohort of young people with PHIV by age and ART. METHODS: This longitudinal, observational study was conducted at a U.K. tertiary PHIV service between November 2018 and March 2022. Bone health was assessed in 130 individuals aged 15-19 (n = 50), 20-24 (n = 50) and 25 years and older (n = 30) by dual-energy X-ray absorptiometry, bone mineralization and turnover markers. Low BMD was defined as lumbar spine (LS) and/or femur-BMD z-score below -2, relative to age, sex and ethnicity-matched U.K. population-based normative controls. Two-year follow-up evaluation was performed in those aged 15-19 (n = 42) and 20-24 years (n = 43) at enrolment, which included a group who switched from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) ART at baseline. Bayesian logistic regression models examined predictors of low BMD and the effect of ART-backbone on BMD accrual. RESULTS: At baseline, 57% were female and 82% of black ethnicity, with 31 (24%) on TDF-ART. Sixteen (12%) had low baseline BMD. Over a median follow-up duration of 26 (interquartile range [IQR] 25-29) months, BMD accrual was lower-than-expected in those aged 15-19 years (mean change LS-BMD z-score -0.15 (standard deviation [SD] 0.44)), when compared to normative controls. No associations were seen with HIV parameters or the ART regimen. Participants who switched to TAF-ART had similar BMD accrual 26 (IQR 24-32) months post switch, when compared to those on non-TAF/TDF-ART (mean change LS-BMD z-score TAF -0.01 [SD 0.41] vs. non-TAF/TDF -0.03 [SD 0.54]). CONCLUSIONS: While rates of low BMD were reassuringly low in this cohort, lower-than-expected BMD accrual was observed in younger individuals, relative to normative controls. Overall, BMD accrual on TAF-ART was non-inferior to non-TAF/TDF-ART.
Date Issued
2025-09-01
Date Acceptance
2025-08-12
Citation
Journal of the International AIDS Society, 2025, 28 (9)
ISSN
1758-2652
Publisher
Wiley
Start Page
e70029
Journal / Book Title
Journal of the International AIDS Society
Volume
28
Issue
9
Copyright Statement
© 2025 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40904314
Subjects
Absorptiometry, Photon
Adolescent
Adult
Anti-HIV Agents
Bone Density
Female
HIV Infections
HIV-1
Humans
Infectious Disease Transmission, Vertical
Longitudinal Studies
Male
Young Adult
antiretroviral therapy
bone health
bone mass
bone mineral density
perinatal HIV
vitamin D
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
e70029
Date Publish Online
2025-09-04