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

Stephen M. Arpadi, Stephanie Shiau, Renate Strehlau, Faeezah Patel, Ndileka Mbete, Donald J. McMahon, Jonathan J. Kaufman, Ashraf Coovadia, Louise Kuhn, Michael T. Yin

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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 HIVuninfected 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 HIVinfected children was 5.7 years. Whole-body BMC Z-score was 0.17 lower for HIVinfected 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.

Original languageEnglish (US)
Pages (from-to)2459-2467
Number of pages9
Issue number16
StatePublished - Oct 23 2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


  • Antiretroviral therapy
  • Bone
  • Children
  • Efavirenz
  • Pediatrics


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