The effect of daily oral PrEP use during pregnancy on bone mineral density among adolescent girls and young women in Uganda.

Autor:	Zewdie K; Department of Epidemiology, University of Washington, Seattle, WA, United States.; Department of Global Health, University of Washington, Seattle, WA, United States., Kiweewa FM; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda., Ssebuliba T; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Morrison SA; Department of Global Health, University of Washington, Seattle, WA, United States., Muwonge TR; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Boyer J; Department of Medicine, Division of Infectious Disease, Columbia University, New York, NY, United States., Bambia F; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Badaru J; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Stein G; Department of Global Health, University of Washington, Seattle, WA, United States., Mugwanya KK; Department of Epidemiology, University of Washington, Seattle, WA, United States.; Department of Global Health, University of Washington, Seattle, WA, United States., Wyatt C; Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, United States., Yin MT; Department of Medicine, Division of Infectious Disease, Columbia University, New York, NY, United States., Mujugira A; Infectious Diseases Institute, Makerere University, Kampala, Uganda.; Department of Global Health, University of Washington, Seattle, WA, United States., Heffron R; Department of Global Health, University of Washington, Seattle, WA, United States.; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in reproductive health [Front Reprod Health] 2024 Jan 08; Vol. 5, pp. 1240990. Date of Electronic Publication: 2024 Jan 08 (Print Publication: 2023).
DOI:	10.3389/frph.2023.1240990
Abstrakt:	Introduction: Oral pre-exposure prophylaxis (PrEP) is recommended during pregnancy for at-risk cisgender women. Pregnancy is known to impede bone growth and tenofovir-based PrEP may also yield detrimental changes to bone health. Thus, we evaluated the effect of PrEP use during pregnancy on bone mineral density (BMD). Methods: We used data from a cohort of women who were sexually active, HIV-negative, ages 16-25 years, initiating DMPA or choosing condoms for contraception and enrolled in the Kampala Women's Bone Study. Women were followed quarterly with rapid testing for HIV and pregnancy, PrEP dispensation, and adherence counseling. Those who became pregnant were counseled on PrEP use during pregnancy per national guidelines. BMD of the neck of the hip, total hip, and lumbar spine was measured using dual-energy x-ray absorptiometry at baseline and annually. We compared the mean percent change in BMD from baseline to month 24. Results: Among 499 women enrolled in the study, 105 pregnancies occurred in 90 women. At enrollment, the median age was 20 years (IQR: 19-21) and 89% initiated PrEP. During pregnancy, 67% of women continued using PrEP and PrEP was dispensed in 64% of visits. BMD declined significantly in women using PrEP during pregnancy compared to women who were not pregnant nor used PrEP: relative BMD change was -2.26% (95% CI: -4.63 to 0.11, p  = 0.06) in the femoral neck, -2.57% (95% CI: -4.48 to -0.66, p  = 0.01) in total hip, -3.06% (95% CI: -5.49 to -0.63, p  = 0.001) lumbar spine. There was no significant difference in BMD loss when comparing PrEP-exposed pregnant women to pregnant women who never used PrEP. Women who became pregnant were less likely to continue PrEP at subsequent study visits than women who did not become pregnant (adjOR: 0.25, 95% CI: 0.16-0.37, p  < 0.001). Based on pill counts, there was a 62% reduction in the odds of high PrEP adherence during pregnancy (adjOR = 0.38, 95% CI: 0.27-0.58, p  < 0.001). Conclusion: Women who used PrEP during pregnancy experienced a similar reduction in BMD as pregnant women with no PrEP exposure, indicating that BMD loss in PrEP-using pregnant women is largely driven by pregnancy and not PrEP. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2024 Zewdie, Kiweewa, Ssebuliba, Morrison, Muwonge, Boyer, Bambia, Badaru, Stein, Mugwanya, Wyatt, Yin, Mujugira and Heffron.)
Databáze:	MEDLINE
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