RESEARCH ARTICLE Antiretroviral Therapy, Especially Efavirenz, Is Associated with Low Bone Mineral Density in HIV-Infected South Africans

Purpose We determined the prevalence and correlates of low bone mineral density (BMD) in HIV-infected South Africans as there is a paucity of such data from Africa. Methods BMD and serum 25-hydroxyvitamin D were measured in HIV-positive participants on antire-troviral therapy (ART) and in those not yet on ART (ART-naïve). Results We enrolled 444 participants [median age 35(IQR: 30, 40) years; 77 % women]. BMD was low (z score <-2SD) in 17 % and 5 % of participants at the lumbar spine and total hip, respec-tively. Total hip [0.909 (SD 0.123) vs 0.956 (SD 0.124) g/cm2, p = 0.0001] and neck of femur BMD [0.796 (SD 0.130) vs 0.844 (SD 0.120) g/cm2, p = 0.0001] were lower in the ART, com-pared to the ART-naïve group. Vitamin D deficiency was present in 15 % of participants and was associated with efavirenz use [adjusted OR 2.04 (95 % CI 1.01 to 4.13)]. In a multivari-ate linear regression, exposure to efavirenz or lopinavir-based ART was associated wit