Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans

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dc.contributor.authorDave, Joel Aen_ZA
dc.contributor.authorCohen, Karenen_ZA
dc.contributor.authorMicklesfield, Lisa Ken_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.contributor.authorLevitt, Naomi Sen_ZA
dc.date.accessioned2015-12-20T16:04:16Z
dc.date.available2015-12-20T16:04:16Z
dc.date.issued2015en_ZA
dc.description.abstractPurpose 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/cm 2 , p = 0.0001] and neck of femur BMD [0.796 (SD 0.130) vs 0.844 (SD 0.120) g/cm 2 , 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 R 2 = 0.28). Age, weight, sex, and the use of efavirenz-based ART were independently associated with lumbar spine BMD (adjusted R 2 = 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.en_ZA
dc.identifier.apacitationDave, J. A., Cohen, K., Micklesfield, L. K., Maartens, G., & Levitt, N. S. (2015). Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans. <i>PLoS One</i>, http://hdl.handle.net/11427/15912en_ZA
dc.identifier.chicagocitationDave, Joel A, Karen Cohen, Lisa K Micklesfield, Gary Maartens, and Naomi S Levitt "Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/15912en_ZA
dc.identifier.citationDave, J. A., Cohen, K., Micklesfield, L. K., Maartens, G., & Levitt, N. S. (2015). Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans. PloS one, 10(12). doi:10.1371/journal.pone.0144286en_ZA
dc.identifier.ris TY - Journal Article AU - Dave, Joel A AU - Cohen, Karen AU - Micklesfield, Lisa K AU - Maartens, Gary AU - Levitt, Naomi S AB - 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/cm 2 , p = 0.0001] and neck of femur BMD [0.796 (SD 0.130) vs 0.844 (SD 0.120) g/cm 2 , 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 R 2 = 0.28). Age, weight, sex, and the use of efavirenz-based ART were independently associated with lumbar spine BMD (adjusted R 2 = 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. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0144286 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans TI - Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans UR - http://hdl.handle.net/11427/15912 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15912
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0144286
dc.identifier.vancouvercitationDave JA, Cohen K, Micklesfield LK, Maartens G, Levitt NS. Antiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africans. PLoS One. 2015; http://hdl.handle.net/11427/15912.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Endocrinology and Diabetologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Dave et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHipen_ZA
dc.subject.otherVitamin Den_ZA
dc.subject.otherVitamin D deficiencyen_ZA
dc.subject.otherBone densityen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherLinear regression analysisen_ZA
dc.subject.otherAfricansen_ZA
dc.titleAntiretroviral therapy, especially Efavirenz, is associated with low bone mineral density in HIV-infected South Africansen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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