Reduced bone mineral density among HIV infected patients on anti-retroviral therapy in Blantyre, Malawi: Prevalence and associated factors.

Introduction: Use of tenofovir based anti-retroviral therapy (ART) in HIV patients is associated with low bone mineral density (BMD). Low BMD predisposes people living with HIV (PLWHIV) to fractures thereby increasing morbidity and mortality. Since the introduction of tenofovir based ARV regimens in 2011, information on the prevalence of low BMD in PLWHIV and receiving ART is still scarce in Malawi. This study aimed to determine the prevalence and associated factors of low BMD among adults living with HIV and receiving ART in Blantyre, Malawi.

Methodology: This was a cross sectional study involving 282 HIV-positive adults of whom 102 (36%) were males. The participants aged 18-45 years were recruited from three primary and one tertiary health care facilities. Patients with no other comorbidities or conditions associated with low BMD and on ART >12 months were included. Data on BMD (femoral neck and lumbar spine) were collected using Dual-Energy X-ray Absorptiometry (DEXA). The International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity (PA) levels. Participants' body weight (kg) and height (m) were also measured. Descriptive statistics, Chi-Square test and multivariable logistic regression were used to analyse data.

Results: Mean age of participants was 37(± 6.4) years, mean duration on ART was 5(± 3.5) years and mean body mass index (BMI) was 23(± 4.5) kg/m2. Twenty percent (55) had reduced BMD. More males (28%) had reduced BMD than females (14%) (p = 0.04). There was a significant association between lumbar BMD and femoral neck BMD (r = 0.66,p<0.001). However, on average, lumbar BMD (g/cm2) was significantly lower than the femoral BMD (p < 0.001). Participants with low PA level (OR 1.23,p = 0.6) had higher odds of having reduced BMD compared to those with high PA level.

Conclusions And Recommendation: Prevalence of reduced BMD is high among PLWHIV in Malawi especially male Malawian adults. Occurrence of low BMD is associated with low PA level. There is need for health care providers to routinely monitor BMD and PA levels of this population.