Bone health in a U.K. cohort of youth living with perinatally acquired HIV-1: a longitudinal study

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-09-04 DOI:10.1002/jia2.70029

Merle Henderson, Alexandra Blenkinsop, Oliver Ratmann, Moira Cheung, Hermione Lyall, Sarah Fidler, Caroline Foster, the BONDY study group

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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.

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英国一群围产期获得性HIV-1青年患者的骨骼健康：一项纵向研究

围产期获得性艾滋病毒（PHIV）的儿童和年轻人骨密度低，这可能与传统（如低体重指数和营养不良）和艾滋病毒相关的危险因素（如长期暴露于艾滋病毒和抗逆转录病毒治疗[ART]，免疫抑制，慢性免疫激活和炎症）有关。在这里，我们根据年龄和抗逆转录病毒治疗评估了英国一组感染艾滋病毒的年轻人的骨密度。方法：这项纵向观察性研究于2018年11月至2022年3月在英国三级hiv服务中心进行。通过双能x线吸收仪、骨矿化和转换标志物对130名年龄在15-19岁（n = 50）、20 - 24岁（n = 50）和25岁及以上（n = 30）的个体进行骨健康评估。低骨密度被定义为腰椎（LS）和/或股骨骨密度z-score低于- 2，相对于年龄、性别和种族匹配的英国人群标准对照。在入组时年龄为15 - 19岁（n = 42）和20 - 24岁（n = 43）的患者中进行了为期两年的随访评估，其中包括一组在基线时从富马酸替诺福韦二氧吡酯（TDF）转为替诺福韦α胺（TAF） ART的患者。贝叶斯逻辑回归模型检验了低骨密度的预测因子和ART-backbone对骨密度增加的影响。结果基线时，57%为女性，82%为黑人，其中31人（24%）接受TDF-ART治疗。16例（12%）基线骨密度低。中位随访时间为26个月（四分位数范围[IQR] 25-29），与规范对照组相比，15 - 19岁的患者骨密度增加低于预期（平均变化LS-BMD z-score - 0.15（标准差[SD] 0.44））。与HIV参数或ART治疗方案没有关联。与非TAF/TDF- art患者相比，转换为TAF- art的参与者在转换后26 （IQR 24-32）个月的骨密度增加相似（平均变化LS-BMD z-score TAF- 0.01 [SD 0.41]与非TAF/TDF- 3 [SD 0.54]）。结论：虽然在这个队列中，低骨密度的发生率很低，但相对于规范对照，在年轻人中观察到低于预期的骨密度累积。总体而言，TAF-ART治疗的BMD累积不低于非taf /TDF-ART治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.