Vitamin D insufficiency is associated with impaired bone density among adolescents with perinatally-acquired HIV infection

Nyasha V. Dzavakwa; Victoria Simms; Celia L Gregson; Molly Chisenga; Suzanne Filteau; Lackson Kasonka; Katharina Kranzer; Hilda Mujuru; The VITALITY team; et al

doi:10.1093/ofid/ofae442

Vitamin D insufficiency is associated with impaired bone density among adolescents with perinatally-acquired HIV infection

Nyasha V. Dzavakwa^*, Victoria Simms^*, Celia L Gregson, Molly Chisenga, Suzanne Filteau, Lackson Kasonka, Katharina Kranzer, Hilda Mujuru, The VITALITY team, et al

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Background
Stunting and pubertal delay are common among children growing up with human immunodeficiency virus (HIV) and are associated with bone and muscle impairments. We investigated factors associated with bone density and muscle function in adolescents living with HIV (ALWH).

Methods
The VITALITY trial (PACTR202009897660297) investigated whether vitamin D and calcium supplementation improves musculoskeletal health among ALWH. A total of 842 ALWH aged 11–19 years, established on antiretroviral therapy (ART) for ≥6 months, were enrolled from HIV clinics in Zambia and Zimbabwe. Clinical history and examination were undertaken, and serum 25-hydroxyvitamin D3 (25[OH]D3) was measured. Dual-energy X-ray absorptiometry measured total-body-less-head bone mineral density adjusted for height (TBLH-BMDHT), and lumbar spine bone mineral apparent density (LS-BMAD) z scores. The association between a priori–defined covariates and musculoskeletal outcomes were investigated using baseline enrollment data and multivariable logistic regression.

Results
TBLH-BMDHT z scores were impaired (mean, −1.42 for male and −0.63 female participants), as were LS-BMAD z scores (mean −1.15 for male and −0.47 for female participants). In bivariate analysis, early pubertal stage, less physical activity, and older age at ART initiation were associated with lower TBLH-BMDHT z scores. Younger age, early pubertal stage, and low socioeconomic status were associated with lower LS-BMAD z scores. Grip-strength-for-height and jump-power-for-height z scores were associated with lower TBLH-BMDHT and LS-BMAD z scores. Low dietary vitamin D and calcium were associated with lower adjusted TBLH-BMDHT z scores. Lower 25(OH)D3 was associated with lower adjusted TBLH-BMDHT and LS-BMAD z scores.

Conclusions
Deficits in bone density are common in ALWH. Vitamin D and calcium supplementation and promotion of exercise may improve musculoskeletal health among perinatally infected ALWH.

Original language	English
Article number	ofae442
Number of pages	11
Journal	Open Forum Infectious Diseases
Volume	11
Issue number	9
Early online date	19 Sept 2024
DOIs	https://doi.org/10.1093/ofid/ofae442
Publication status	E-pub ahead of print - 19 Sept 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

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Dzavakwa, N. V., Simms, V., Gregson, C. L., Chisenga, M., Filteau, S., Kasonka, L., Kranzer, K., Mujuru, H., The VITALITY team, & al, E. (2024). Vitamin D insufficiency is associated with impaired bone density among adolescents with perinatally-acquired HIV infection. Open Forum Infectious Diseases, 11(9), Article ofae442. Advance online publication. https://doi.org/10.1093/ofid/ofae442

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title = "Vitamin D insufficiency is associated with impaired bone density among adolescents with perinatally-acquired HIV infection",

abstract = "Background Stunting and pubertal delay are common among children growing up with human immunodeficiency virus (HIV) and are associated with bone and muscle impairments. We investigated factors associated with bone density and muscle function in adolescents living with HIV (ALWH). Methods The VITALITY trial (PACTR202009897660297) investigated whether vitamin D and calcium supplementation improves musculoskeletal health among ALWH. A total of 842 ALWH aged 11–19 years, established on antiretroviral therapy (ART) for ≥6 months, were enrolled from HIV clinics in Zambia and Zimbabwe. Clinical history and examination were undertaken, and serum 25-hydroxyvitamin D3 (25[OH]D3) was measured. Dual-energy X-ray absorptiometry measured total-body-less-head bone mineral density adjusted for height (TBLH-BMDHT), and lumbar spine bone mineral apparent density (LS-BMAD) z scores. The association between a priori–defined covariates and musculoskeletal outcomes were investigated using baseline enrollment data and multivariable logistic regression. Results TBLH-BMDHT z scores were impaired (mean, −1.42 for male and −0.63 female participants), as were LS-BMAD z scores (mean −1.15 for male and −0.47 for female participants). In bivariate analysis, early pubertal stage, less physical activity, and older age at ART initiation were associated with lower TBLH-BMDHT z scores. Younger age, early pubertal stage, and low socioeconomic status were associated with lower LS-BMAD z scores. Grip-strength-for-height and jump-power-for-height z scores were associated with lower TBLH-BMDHT and LS-BMAD z scores. Low dietary vitamin D and calcium were associated with lower adjusted TBLH-BMDHT z scores. Lower 25(OH)D3 was associated with lower adjusted TBLH-BMDHT and LS-BMAD z scores. Conclusions Deficits in bone density are common in ALWH. Vitamin D and calcium supplementation and promotion of exercise may improve musculoskeletal health among perinatally infected ALWH.",

author = "Dzavakwa, \{Nyasha V.\} and Victoria Simms and Gregson, \{Celia L\} and Molly Chisenga and Suzanne Filteau and Lackson Kasonka and Katharina Kranzer and Hilda Mujuru and \{The VITALITY team\} and et al",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024. ",

year = "2024",

month = sep,

day = "19",

doi = "10.1093/ofid/ofae442",

language = "English",

volume = "11",

journal = "Open Forum Infectious Diseases",

issn = "2328-8957",

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TY - JOUR

T1 - Vitamin D insufficiency is associated with impaired bone density among adolescents with perinatally-acquired HIV infection

AU - Dzavakwa, Nyasha V.

AU - Simms, Victoria

AU - Gregson, Celia L

AU - Chisenga, Molly

AU - Filteau, Suzanne

AU - Kasonka, Lackson

AU - Kranzer, Katharina

AU - Mujuru, Hilda

AU - The VITALITY team

AU - al, et

PY - 2024/9/19

Y1 - 2024/9/19

N2 - Background Stunting and pubertal delay are common among children growing up with human immunodeficiency virus (HIV) and are associated with bone and muscle impairments. We investigated factors associated with bone density and muscle function in adolescents living with HIV (ALWH). Methods The VITALITY trial (PACTR202009897660297) investigated whether vitamin D and calcium supplementation improves musculoskeletal health among ALWH. A total of 842 ALWH aged 11–19 years, established on antiretroviral therapy (ART) for ≥6 months, were enrolled from HIV clinics in Zambia and Zimbabwe. Clinical history and examination were undertaken, and serum 25-hydroxyvitamin D3 (25[OH]D3) was measured. Dual-energy X-ray absorptiometry measured total-body-less-head bone mineral density adjusted for height (TBLH-BMDHT), and lumbar spine bone mineral apparent density (LS-BMAD) z scores. The association between a priori–defined covariates and musculoskeletal outcomes were investigated using baseline enrollment data and multivariable logistic regression. Results TBLH-BMDHT z scores were impaired (mean, −1.42 for male and −0.63 female participants), as were LS-BMAD z scores (mean −1.15 for male and −0.47 for female participants). In bivariate analysis, early pubertal stage, less physical activity, and older age at ART initiation were associated with lower TBLH-BMDHT z scores. Younger age, early pubertal stage, and low socioeconomic status were associated with lower LS-BMAD z scores. Grip-strength-for-height and jump-power-for-height z scores were associated with lower TBLH-BMDHT and LS-BMAD z scores. Low dietary vitamin D and calcium were associated with lower adjusted TBLH-BMDHT z scores. Lower 25(OH)D3 was associated with lower adjusted TBLH-BMDHT and LS-BMAD z scores. Conclusions Deficits in bone density are common in ALWH. Vitamin D and calcium supplementation and promotion of exercise may improve musculoskeletal health among perinatally infected ALWH.

AB - Background Stunting and pubertal delay are common among children growing up with human immunodeficiency virus (HIV) and are associated with bone and muscle impairments. We investigated factors associated with bone density and muscle function in adolescents living with HIV (ALWH). Methods The VITALITY trial (PACTR202009897660297) investigated whether vitamin D and calcium supplementation improves musculoskeletal health among ALWH. A total of 842 ALWH aged 11–19 years, established on antiretroviral therapy (ART) for ≥6 months, were enrolled from HIV clinics in Zambia and Zimbabwe. Clinical history and examination were undertaken, and serum 25-hydroxyvitamin D3 (25[OH]D3) was measured. Dual-energy X-ray absorptiometry measured total-body-less-head bone mineral density adjusted for height (TBLH-BMDHT), and lumbar spine bone mineral apparent density (LS-BMAD) z scores. The association between a priori–defined covariates and musculoskeletal outcomes were investigated using baseline enrollment data and multivariable logistic regression. Results TBLH-BMDHT z scores were impaired (mean, −1.42 for male and −0.63 female participants), as were LS-BMAD z scores (mean −1.15 for male and −0.47 for female participants). In bivariate analysis, early pubertal stage, less physical activity, and older age at ART initiation were associated with lower TBLH-BMDHT z scores. Younger age, early pubertal stage, and low socioeconomic status were associated with lower LS-BMAD z scores. Grip-strength-for-height and jump-power-for-height z scores were associated with lower TBLH-BMDHT and LS-BMAD z scores. Low dietary vitamin D and calcium were associated with lower adjusted TBLH-BMDHT z scores. Lower 25(OH)D3 was associated with lower adjusted TBLH-BMDHT and LS-BMAD z scores. Conclusions Deficits in bone density are common in ALWH. Vitamin D and calcium supplementation and promotion of exercise may improve musculoskeletal health among perinatally infected ALWH.

U2 - 10.1093/ofid/ofae442

DO - 10.1093/ofid/ofae442

M3 - Article (Academic Journal)

C2 - 39301108

SN - 2328-8957

VL - 11

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

IS - 9

M1 - ofae442

ER -

Vitamin D insufficiency is associated with impaired bone density among adolescents with perinatally-acquired HIV infection

Abstract

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