Determining Bone Loss and Bone Mineral Density Recovery Following Repeat Pregnancy/Lactation Among HIV Women on ART

DXA R01项目总结 Promise 1077BF试验发现18个月后骨密度(BMD)显著降低 期间随机接受抗逆转录病毒治疗(ART)的无症状HIV感染母亲的分娩 与婴儿随机接受奈韦拉平治疗的母亲相比，延长母乳喂养时间 母乳喂养期间的预防措施。母乳喂养也与BMD的一过性下降有关，但通常 然后是骨密度恢复。在感染艾滋病毒的女性中，终身ART的长期影响与重复 艾滋病毒感染母亲的怀孕/重复哺乳对母亲骨密度的影响仍不清楚。然而，我们的 Promise关于母乳喂养期间抗逆转录病毒治疗的BMD下降的初步发现引发了人们对 与未感染艾滋病毒的母亲相比，早期骨量减少或骨质疏松的潜在风险增加 而不是接触到毕生的艺术。 考虑到这些有希望的发现，我们建议对重复妊娠时的骨密度变化进行纵向追踪。 Promise试验中感染艾滋病毒的母亲延长了母乳喂养时间，这些母亲现在已经参加了 促进在马拉维布兰太尔和乌干达坎帕拉进行队列后续研究，以便更好地 了解影响HIV感染妇女终身抗逆转录病毒治疗后骨密度丢失和恢复模式的因素。 目标1：我们将在进入PROCESS时收集基准骨密度数据，并与 为评估HIV感染妇女低骨密度临床危险因素的变化 目的2：对再次妊娠的HIV感染者进行随诊，测定BMD 丢失和恢复模式：产后36个月随访骨生物标记物变化 将结果与年龄组、产次和部位匹配的HIV阴性孕妇进行比较； 目的3：将骨密度和骨生物标记物结果与年龄组、产次和胎次相匹配的促进母亲进行比较 但在36个月的随访中没有怀孕的人。 这项研究将阐明在终生抗逆转录病毒治疗中感染艾滋病毒的母亲的骨密度降低是否 反复怀孕/哺乳并在哺乳结束时骨密度恢复下降而加重 与艾滋病毒阴性的妇女相比，在母乳喂养结束时。

DXA R01 Project Summary The PROMISE 1077BF trial found significantly decreased Bone Mineral Density (BMD) by 18 months post delivery among asymptomatic HIV infected mothers randomized to receive antiretroviral therapy (ART) during extended breastfeeding when compared to mothers whose infants were randomized to receive nevirapine prophylaxis during breastfeeding. Breastfeeding is also associated with transient decreases in BMD but usually followed by BMD recovery. Among HIV infected women, the longer term impact of life time ART with repeat pregnancy/repeat breastfeeding on maternal BMD of HIV infected mothers remains unknown. However our initial findings from PROMISE on BMD decreases seen with ART during breastfeeding raise concerns over a potential increased risk of early osteopenia or osteoporosis when compared to mothers are not HIV infected and not exposed to lifetime ART. Given these PROMISE findings, we propose a longitudinal follow up of BMD changes with repeat pregnancy and extended breastfeeding among HIV infected mothers from the PROMISE trial who are now enrolled in the PROMOTE cohort follow up study at the Blantyre Malawi and the Kampala Uganda site, in order to better understand factors affecting both lose and recovery patterns of BMD for HIV infected women on lifetime ART. AIM 1: We will gather baseline BMD data at entry into PROMOTE and compare to prior DXA measures in PROMISE in order to assess changes clinical risk factors for low BMD in HIV Infected women AIM 2: for HIV infected women who have a repeat pregnancy during PROMOTE follow up, determine BMD loss and recovery patterns: and bone biomarker changes during 36 months follow up post delivery and compare results to age group, parity and site matched HIV negative pregnant women; AIM 3: compare BMD and bone biomarker findings with PROMOTE mothers matched for age group, parity and site but who do not conceive during 36 months of follow up. This research will elucidate whether decreases in BMD among HIV infected mothers on lifetime ART are exacerbated with repeat pregnancy/breastfeeding and if BMD recovery at the end of breastfeeding is decrease when compared to HIV negative women at the end of breastfeeding.