Reduced bone mineral density among people living with HIV and receiving anti-retroviral therapy in Blantyre, Malawi: Pharmacological challenges, prevalence and the role of exercise
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Date
2021-01-01
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Abstract
Reduced bone mineral density (BMD) is common among people living with HIV (PLWHIV)
following the use of tenofovir (TDF) based antiretroviral therapy (ART) drugs. Although
pharmacological therapies used to manage reduced BMD are associated with adverse effects,
non-pharmacological strategies to manage reduced BMD resulting from ART drugs in PLWHIV
have not been investigated. Despite evidence that exercise is effective in increasing BMD, there
has been minimum effort to investigate effects of exercise on low BMD resulting from ART
drugs in PLWHIV. The purpose of the research project was to investigate the prevalence of
reduced BMD with its associated factors and the role of exercise in increasing bone mineral
density among people living with HIV and receiving antiretroviral therapy in Blantyre, Malawi.
This was a cross sectional and randomised controlled study involving HIV-positive adults
receiving TDF based ART recruited from Blantyre, Malawi. Data on prevalence of BMD and
physical activity (PA) was collected using the Dual Energy X-ray Absorptiometry (DEXA) and a
global PA questionnaire. Eligible and willing participants with reduced BMD were then
randomised into either maximal strength training group (TG) or control group (CG). Variables of
BMD, Peak Oxygen Uptake (VO2max), Peak Heartrate (HRpeak) and One repetition maximum
(1 RM) were obtained and analysed at base line and after the exercise intervention in both the
TG and CG. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS)
version 21. Descriptive statistics using mean and standard deviation (SD) were used to
characterize demographic variables. Student T – tests were used to analyse the differences
between TG and CG. Out of 282 participants, 55 (20%) had low BMD while 227 (80%) had their
BMD within the expected ranges for age. Most participants (40%) had low PA levels, followed
by those who were moderately physically active (36%) while a smaller number of participants
(24%) had high PA levels. Participants with low PA level (OR 1.23, p = 0.6) were more likely to
have reduced BMD than those with high PA level. Data of 24 participants with reduced BMD
randomised into TG (14) and CG (10) were analysed. After the intervention, there were
significant improvements in lumbar BMD (p <0.001) and resting heart rate (p = 0.03) in the TG
compared to the CG. There were significant improvements in 1 RM in both the TG (p <0.001)
and the CG (p = 0.01). Prevalence of reduced BMD is high among PLWHIV in Malawi
especially male Malawian adults. Most PLWHIV and receiving ART in the sample had low PA
levels. The occurrence of reduced BMD was more likely among participants with low PA level.
Maximal strength training improves lumbar BMD, resting herat rate and strength in PLWHIV
receiving ART in Blantyre, Malawi