Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe

Cynthia Mukwasi‐Kahari; Andrea M Rehman; Mícheál Ó Breasail; Ruramayi Rukuni; Tafadzwa Madanhire; Joseph Chipanga; Lynda Stranix‐Chibanda; Lisa K Micklesfield; Rashida A Ferrand; Kate A Ward; Celia L Gregson

doi:10.1002/jbmr.4752

Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe

Cynthia Mukwasi‐Kahari^*, Andrea M Rehman, Mícheál Ó Breasail, Ruramayi Rukuni, Tafadzwa Madanhire, Joseph Chipanga, Lynda Stranix‐Chibanda, Lisa K Micklesfield, Rashida A Ferrand, Kate A Ward, Celia L Gregson

^*Corresponding author for this work

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Abstract

HIV infection has multi-system adverse effects in children, including on the growing skeleton. We aimed to determine the association between chronic HIV infection and bone architecture (density, size, strength) in peripubertal children. We conducted a cross-sectional study of children aged 8 to 16 years with HIV (CWH) on antiretroviral therapy (ART) and children without HIV (CWOH) recruited from schools and frequency-matched for age strata and sex. Outcomes, measured by tibial peripheral quantitative computed tomography (pQCT), included 4% trabecular and 38% cortical volumetric bone mineral density (vBMD), 4% and 38% cross-sectional area (CSA), and 38% stress–strain index (SSI). Multivariable linear regression tested associations between HIV status and outcomes, stratified by sex and puberty (Tanner 1–2 versus 3–5), adjusting for age, height, fat mass, physical activity, and socioeconomic and orphanhood statuses. We recruited 303 CWH and 306 CWOH; 50% were female. Although CWH were similar in age to CWOH (overall mean ± SD 12.4 ± 2.5 years), more were prepubertal (ie, Tanner 1; 41% versus 23%). Median age at ART initiation was 4 (IQR 2–7) years, whereas median ART duration was 8 (IQR 6–10) years. CWH were more often stunted (height-for-age Z-score

Original language	English
Journal	Journal of Bone and Mineral Research
Early online date	25 Nov 2022
DOIs	https://doi.org/10.1002/jbmr.4752
Publication status	E-pub ahead of print - 25 Nov 2022

Bibliographical note

Funding Information:
CM‐K is funded by a National Institute of Health Fogarty Trent Fellowship (grant number 2D43TW009539‐06). RR is funded by the Wellcome Trust (grant number 206764/Z/17/Z). Global challenges research funding from the University of Bristol and an Academy of Medical Sciences GCRF Networking Grant (grant number GCRFNG100399) established the sub‐Saharan African Musculoskeletal Network (SAMSON) and provided the peripheral quantitative computed tomography scanner in Zimbabwe for this study. AMR is partially supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, which is also part of the European and Developing Countries Clinical Trials Partnership 2 programme supported by the EU (grant number MR/R010161/1). RAF is funded by the Wellcome Trust (grant number 206316/Z/17/Z).

Publisher Copyright:
© 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Mukwasi‐Kahari, C., Rehman, A. M., Ó Breasail, M., Rukuni, R., Madanhire, T., Chipanga, J., Stranix‐Chibanda, L., Micklesfield, L. K., Ferrand, R. A., Ward, K. A., & Gregson, C. L. (2022). Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe. Journal of Bone and Mineral Research. Advance online publication. https://doi.org/10.1002/jbmr.4752

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title = "Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe",

abstract = "HIV infection has multi-system adverse effects in children, including on the growing skeleton. We aimed to determine the association between chronic HIV infection and bone architecture (density, size, strength) in peripubertal children. We conducted a cross-sectional study of children aged 8 to 16 years with HIV (CWH) on antiretroviral therapy (ART) and children without HIV (CWOH) recruited from schools and frequency-matched for age strata and sex. Outcomes, measured by tibial peripheral quantitative computed tomography (pQCT), included 4% trabecular and 38% cortical volumetric bone mineral density (vBMD), 4% and 38% cross-sectional area (CSA), and 38% stress–strain index (SSI). Multivariable linear regression tested associations between HIV status and outcomes, stratified by sex and puberty (Tanner 1–2 versus 3–5), adjusting for age, height, fat mass, physical activity, and socioeconomic and orphanhood statuses. We recruited 303 CWH and 306 CWOH; 50% were female. Although CWH were similar in age to CWOH (overall mean ± SD 12.4 ± 2.5 years), more were prepubertal (ie, Tanner 1; 41% versus 23%). Median age at ART initiation was 4 (IQR 2–7) years, whereas median ART duration was 8 (IQR 6–10) years. CWH were more often stunted (height-for-age Z-score ",

author = "Cynthia Mukwasi‐Kahari and Rehman, {Andrea M} and {{\'O} Breasail}, M{\'i}che{\'a}l and Ruramayi Rukuni and Tafadzwa Madanhire and Joseph Chipanga and Lynda Stranix‐Chibanda and Micklesfield, {Lisa K} and Ferrand, {Rashida A} and Ward, {Kate A} and Gregson, {Celia L}",

note = "Funding Information: CM‐K is funded by a National Institute of Health Fogarty Trent Fellowship (grant number 2D43TW009539‐06). RR is funded by the Wellcome Trust (grant number 206764/Z/17/Z). Global challenges research funding from the University of Bristol and an Academy of Medical Sciences GCRF Networking Grant (grant number GCRFNG100399) established the sub‐Saharan African Musculoskeletal Network (SAMSON) and provided the peripheral quantitative computed tomography scanner in Zimbabwe for this study. AMR is partially supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, which is also part of the European and Developing Countries Clinical Trials Partnership 2 programme supported by the EU (grant number MR/R010161/1). RAF is funded by the Wellcome Trust (grant number 206316/Z/17/Z). Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).",

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Mukwasi‐Kahari, C, Rehman, AM, Ó Breasail, M, Rukuni, R, Madanhire, T, Chipanga, J, Stranix‐Chibanda, L, Micklesfield, LK, Ferrand, RA, Ward, KA & Gregson, CL 2022, 'Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe', Journal of Bone and Mineral Research. https://doi.org/10.1002/jbmr.4752

TY - JOUR

T1 - Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy

T2 - A Cross-Sectional Study From Zimbabwe

AU - Mukwasi‐Kahari, Cynthia

AU - Rehman, Andrea M

AU - Ó Breasail, Mícheál

AU - Rukuni, Ruramayi

AU - Madanhire, Tafadzwa

AU - Chipanga, Joseph

AU - Stranix‐Chibanda, Lynda

AU - Micklesfield, Lisa K

AU - Ferrand, Rashida A

AU - Ward, Kate A

AU - Gregson, Celia L

N1 - Funding Information: CM‐K is funded by a National Institute of Health Fogarty Trent Fellowship (grant number 2D43TW009539‐06). RR is funded by the Wellcome Trust (grant number 206764/Z/17/Z). Global challenges research funding from the University of Bristol and an Academy of Medical Sciences GCRF Networking Grant (grant number GCRFNG100399) established the sub‐Saharan African Musculoskeletal Network (SAMSON) and provided the peripheral quantitative computed tomography scanner in Zimbabwe for this study. AMR is partially supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, which is also part of the European and Developing Countries Clinical Trials Partnership 2 programme supported by the EU (grant number MR/R010161/1). RAF is funded by the Wellcome Trust (grant number 206316/Z/17/Z). Publisher Copyright: © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

PY - 2022/11/25

Y1 - 2022/11/25

N2 - HIV infection has multi-system adverse effects in children, including on the growing skeleton. We aimed to determine the association between chronic HIV infection and bone architecture (density, size, strength) in peripubertal children. We conducted a cross-sectional study of children aged 8 to 16 years with HIV (CWH) on antiretroviral therapy (ART) and children without HIV (CWOH) recruited from schools and frequency-matched for age strata and sex. Outcomes, measured by tibial peripheral quantitative computed tomography (pQCT), included 4% trabecular and 38% cortical volumetric bone mineral density (vBMD), 4% and 38% cross-sectional area (CSA), and 38% stress–strain index (SSI). Multivariable linear regression tested associations between HIV status and outcomes, stratified by sex and puberty (Tanner 1–2 versus 3–5), adjusting for age, height, fat mass, physical activity, and socioeconomic and orphanhood statuses. We recruited 303 CWH and 306 CWOH; 50% were female. Although CWH were similar in age to CWOH (overall mean ± SD 12.4 ± 2.5 years), more were prepubertal (ie, Tanner 1; 41% versus 23%). Median age at ART initiation was 4 (IQR 2–7) years, whereas median ART duration was 8 (IQR 6–10) years. CWH were more often stunted (height-for-age Z-score

AB - HIV infection has multi-system adverse effects in children, including on the growing skeleton. We aimed to determine the association between chronic HIV infection and bone architecture (density, size, strength) in peripubertal children. We conducted a cross-sectional study of children aged 8 to 16 years with HIV (CWH) on antiretroviral therapy (ART) and children without HIV (CWOH) recruited from schools and frequency-matched for age strata and sex. Outcomes, measured by tibial peripheral quantitative computed tomography (pQCT), included 4% trabecular and 38% cortical volumetric bone mineral density (vBMD), 4% and 38% cross-sectional area (CSA), and 38% stress–strain index (SSI). Multivariable linear regression tested associations between HIV status and outcomes, stratified by sex and puberty (Tanner 1–2 versus 3–5), adjusting for age, height, fat mass, physical activity, and socioeconomic and orphanhood statuses. We recruited 303 CWH and 306 CWOH; 50% were female. Although CWH were similar in age to CWOH (overall mean ± SD 12.4 ± 2.5 years), more were prepubertal (ie, Tanner 1; 41% versus 23%). Median age at ART initiation was 4 (IQR 2–7) years, whereas median ART duration was 8 (IQR 6–10) years. CWH were more often stunted (height-for-age Z-score

UR - https://doi.org/10.1002/jbmr.4752

U2 - 10.1002/jbmr.4752

DO - 10.1002/jbmr.4752

M3 - Article (Academic Journal)

C2 - 36426511

SN - 0884-0431

JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

ER -

Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe

Abstract

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