The effect of HIV and its treatment on trabecular and cortical bone architecture in children, adolescents and premenopausal women
Funder: National Institute for Health (NIH) Fogarty Fellowship
PI: Ms Cynthia Kahari, LSHTM & Biomedical Research and Training Institute, Zimbabwe
Prompt initiation of antiretroviral therapy (ART) and improved access to treatment has increased the life expectancy of people living with HIV; however, as a result many now live with chronic non-infectious comorbid complications of HIV, such as musculoskeletal disease. Most studies assessing bone in people living with HIV have been performed in high income countries and have used the Dual Energy X-ray Absorptiometry (DXA) method which measures areal bone mineral density. Peripheral Quantitative Computed Tomography (pQCT) provides a detailed assessment of bone yielding volumetric bone density measures of the total, trabecular and cortical bone together with measures of geometry and estimates of bone strength.
This study aims to understand the effect of chronic HIV infection and its treatment on trabecular and cortical bone architecture at different time points through the life course in two independent cohorts from sub-Saharan Africa. The cohort is of children and adolescents followed up for 12 months, and the second of premenopausal women followed up for 24 months. The paediatric cohort is currently in recruitment as part of the IMVASK study (The IMpact of Vertical HIV infection on child and Adolescent Skeletal development in Harare, Zimbabwe) in Harare, Zimbabwe. The adult cohort was collected as part of the Women’s Bone Health study at the MRC/Wits Developmental Pathways for Health Research Unit (DPHRU) in Johannesburg, South Africa. Data collected in both cohorts include socio demographics, clinical history, pQCT measurements of the tibia, radius (adults only), muscle, and DXA measured body composition. Measures will be compared between people living with HIV and people without HIV, within the respective cohorts.
The mechanistic study will improve understanding of the effects of chronic HIV infection on bone geometry and crucial bone strength, shedding insights on future fracture burdens for populations living with HIV in sub-Saharan Africa.