title: Bone mass, body composition and vitamin D status of ARV-naïve, urban, black South African women with HIV infection, stratified by CD₄ count.
abstract: This is the first report examining vitamin D status and bone mass in African women with HIV infection using dual-energy X-ray absorptiometry (DXA) with an appropriate HIV-negative control group. Unlike previous publications, it demonstrates no difference in bone mineral density (BMD) or vitamin D status in HIV-positive patients, at different disease stages, vs. HIV-negative subjects.
  
  
  BACKGROUND
  Low bone mass and poor vitamin D status have been reported among HIV-positive patients; suggesting HIV or its treatment may increase the risk of osteoporosis, a particular concern for women in countries with high HIV prevalence such as South Africa. We describe bone mass and vitamin D status in urban premenopausal South African women, who were HIV positive but not on antiretroviral therapy (ARV).
  
  
  METHODS
  This study is a cross-sectional measurement of BMD and body composition by DXA and vitamin D status by serum 25-hydroxyvitamin D (25(OH)D) concentration. Subjects were recruited into three groups: HIV negative (n = 98) and HIV positive with preserved CD₄ cell count (non-ARV; n = 74) or low CD₄ cell counts prior to ARV initiation (pre-ARV; n = 75).
  
  
  RESULTS
  The mean (standard deviation (SD)) age of women was 32.1 (7.2) years. Mean CD₄ (SD) counts (×10(6)/l) were 412 (91) and 161 (69) in non-ARV and pre-ARV groups (p < 0.0001). Pre-ARV women were significantly lighter and had lower mean BMI than the other two groups (p < 0.002). The pre-ARV group also had significantly less fat and lean mass compared with non-ARV and HIV-negative subjects (p ≤ 0.05). After full adjustment, there were no significant differences in BMD at any site (p > 0.05) between the groups, nor was vitamin D status significantly different between groups (p > 0.05); the mean (SD) cohort 25(OH)D being 60 (18) nmol/l.
  
  
  CONCLUSIONS
  Contrary to previous studies, these HIV-positive women did not have lower BMD or 25(OH)D concentrations than HIV-negative controls, despite the pre-ARV group being lighter with lower BMI.
authors.affiliation: MRC Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, CB1 9NL, Cambridge, UK, matthew.hamill@mrc-hnr.cam.ac.uk.
authors.forename: M M
authors.initials: MM
authors.lastname: Hamill
authors.forename: K A
authors.initials: KA
authors.lastname: Ward
authors.forename: J M
authors.initials: JM
authors.lastname: Pettifor
authors.forename: S A
authors.initials: SA
authors.lastname: Norris
authors.forename: A
authors.initials: A
authors.lastname: Prentice
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000886:Anthropometry / Q000379:methods; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001823:Body Composition / Q000502:physiology*; D015519:Bone Density / Q000502:physiology*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D017697:Premenopause / Q000502:physiology; D014504:Urban Health / Q000706:statistics & numerical data; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D014807:Vitamin D; C104450:25-hydroxyvitamin D