Recovery in bone mineral density following recent repeat pregnancy and breastfeeding among African women with and without HIV.

Abstract

Women living with HIV (WLWH) in resource-limited settings have benefited greatly from antiretroviral therapy (ART). However, they have several risk factors that can affect their bone health including being female, high parity/breastfeeding, use of life-long ART, and HIV disease itself. This study assessed bone mineral density (BMD) among recently pregnant WLWH (WLWH-P), and compared BMD changes over three years with WLWH who were not pregnant (WLWH-NP) and with recently pregnant HIV-negative women (HIV-neg-P). We co-enrolled 104 WLWH-P from an ongoing cohort study in Malawi and Uganda, and used linear mixed models to compare standardized BMD values over 30-36 mo with 109 HIV-neg-P women matched for age-group/parity, and 99 age-group/parity matched WLWH who did not plan to become pregnant over 36 mo. BMD was assessed via dual x-ray absorptiometry (DXA) at baseline, 12, 24 and 30-36 mo. At baseline, median age of WLWH was 33 yr with HIV-neg-P being 32 yr. 91.4% of WLWH-P, and 87.9% of WLWH-NP were on Tenofovir-ART regimens. At baseline, 12, 24 and 30-36 mo postpartum, WLWH-P had lower mean standardized BMD values for femoral neck (FN), lumbar spine (LS) and total hip (TH) compared to HIV-neg-P women, although differences were not statistically significant except for baseline TH. Both groups demonstrated BMD increase to above baseline scores by 30-36 mo. For WLWH-P compared to WLWH-NP, mean standardized BMD values trended lower between baseline and 24 mo. Both WLWH-P and HIV-neg-P women showed BMD recovery to baseline for FN, LS and TH by 30-36 mo postpartum. However, mean BMD standard-scores trended lower throughout follow-up for WLWH-P compared to HIV-neg-P women. WLWH-P and WLWH-NP women had similar BMD standardized scores by 30-36 mo. The BMD recovery results are encouraging, but longer follow-up is needed to assess fracture risk among older WLWH compared to HIV-negative women.