title: Efavirenz is associated with higher bone mass in South African children with HIV.
abstract: We investigate if switching from a ritonavir-boosted lopinavir (LPV/r)-based to an efavirenz-based antiretroviral therapy (ART) regimen is associated with beneficial bone development.
  
  
  
  The CHANGES Bone Study follows HIV-infected children who participated in a noninferiority randomized trial in Johannesburg, South Africa evaluating the safety and efficacy of preemptive switching to efavirenz (n = 106) compared with remaining on LPV/r (n = 113). HIV-uninfected children were also recruited. Whole-body and lumbar spine bone mineral content (BMC) were assessed by dual-energy X-ray absorptiometry at a cross-sectional visit. BMC Z-scores adjusted for sex, age, and height were generated. Physical activity and dietary intake were assessed. CD4 percentage and viral load were measured. We compared bone indices of HIV-infected with HIV-uninfected children and LPV/r with efavirenz by intent-to-treat.
  
  
  
  The 219 HIV-infected (52% boys) and 219 HIV-uninfected (55% boys) children were 6.4 and 7.0 years of age, respectively. Mean ART duration for HIV-infected children was 5.7 years. Whole-body BMC Z-score was 0.17 lower for HIV-infected children compared with HIV-uninfected children after adjustment for physical activity, dietary vitamin D and calcium (P = 0.03). Whole-body BMC Z-score was 0.55 higher for HIV-infected children switched to efavirenz compared with those remaining on LPV/r after adjustment for physical activity, dietary vitamin D and calcium, CD4 percentage, and viral load (P < 0.0001).
  
  
  
  South African HIV-infected children receiving ART have lower bone mass compared with HIV-uninfected controls. Accrued bone mass is positively associated with switching to efavirenz-based ART compared with remaining on LPV/r, providing additional rationale for limiting LPV/r exposure once viral suppression has been achieved.
authors.affiliation: aGertrude H. Sergievsky Center, College of Physicians and Surgeons bDepartment of Epidemiology, Mailman School of Public Health cDepartment of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa eDepartment of Medicine, College of Physicians and Surgeons, Columbia University fDepartment of Orthopedics, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Arpadi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shiau
authors.forename: Renate
authors.initials: R
authors.lastname: Strehlau
authors.forename: Faeezah
authors.initials: F
authors.lastname: Patel
authors.forename: Ndileka
authors.initials: N
authors.lastname: Mbete
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Kaufman
authors.forename: Ashraf
authors.initials: A
authors.lastname: Coovadia
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Michael T
authors.initials: MT
authors.lastname: Yin
mesh_terms: D015502:Absorptiometry, Photon; D000480:Alkynes; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D048588:Benzoxazines / Q000009:adverse effects / Q000627:therapeutic use*; D001846:Bone Development / Q000187:drug effects*; D001842:Bone and Bones / Q000033:anatomy & histology*; D018791:CD4 Lymphocyte Count; D002648:Child; D003430:Cross-Sectional Studies; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D061466:Lopinavir / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use; D013019:South Africa; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000480:Alkynes; D044966:Anti-Retroviral Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D061466:Lopinavir; C098320:efavirenz; D019438:Ritonavir