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Efavirenz is associated with higher bone mass in South African children with HIV.

Efavirenz is associated with higher bone mass in South African children with HIV.
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Arpadi SM, Shiau S, Strehlau R, Patel F, Mbete N, McMahon DJ, Kaufman JJ, Coovadia A, Kuhn L, Yin MT,


Arpadi SM, Shiau S, Strehlau R, Patel F, Mbete N, McMahon DJ, Kaufman JJ, Coovadia A, Kuhn L, Yin MT, (click to view)

Arpadi SM, Shiau S, Strehlau R, Patel F, Mbete N, McMahon DJ, Kaufman JJ, Coovadia A, Kuhn L, Yin MT,

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AIDS (London, England) 30(16) 2459-2467

Abstract
BACKGROUND
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.

METHODS
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.

RESULTS
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). CONCLUSION
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.

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