Bone mineral density changes in breastfeeding women with HIV on antiretroviral therapy in Eastern and Southern Africa.

Abstract

Objective: The aim of this study was to describe postpartum bone mineral density (BMD) change among breastfeeding African women with HIV (WHIV) on life-long antiretroviral therapy (ART).

Design: In IMPAACT P1084 s, postpartum BMD declines were greater in WHIV randomized to ART to prevent breastmilk transmission compared to infant nevirapine prophylaxis. This analysis extends the observation period through entry to a follow-on observational study, PROMOTE.

Methods: Lumbar spine, total hip, and femoral neck BMD were assessed using dual energy x-ray absorptiometry (DXA) at postpartum weeks 1 and 74 in P1084 s, and at PROMOTE entry. Participants were included if DXA data were available from PROMOTE entry and more than one earlier timepoint. Country-specific Z-scores were created by internal standardization to week 1 values. Linear mixed models, adjusted for country, estimated the average 5-year change in BMD z -scores between postpartum week 1 and PROMOTE entry. Linear regression assessed the association between maternal characteristics and the rate of change in BMD z -score.

Results: We included BMD data from 519 participants between postpartum week 1 through PROMOTE entry [median (IQR) 4.6 (3.5-5.1) years postpartum]. For every 5 years passed, lumbar spine BMD Z -scores increased by + 0.250 units, while total hip and femoral neck BMD z -scores decreased by -0.173 and -0.141 units, respectively. Lumbar spine, total hip, and femoral neck BMD increased between postpartum week 74 and PROMOTE entry, but only lumbar spine BMD fully recovered to week 1 values.

Conclusion: Given dampened total hip and femoral neck BMD recovery postbreastfeeding, longer term monitoring is needed to assess peri-/postmenopausal fracture risk, and interventions to optimize bone health among WLHIV on life-long ART.