Longitudinal Study of Bone Mineral Density Changes and Fracture Incidence Following Antiretroviral Therapy Initiation in HIV-Positive Adults in North Central Nigeria

HIV-positive adults initiating antiretroviral therapy (ART) experience accelerated bone loss, particularly in the first 24 months following treatment initiation, increasing fragility fracture risk. The interaction between ART bone toxicity, HIV-related bone disease, nutritional factors, and fracture incidence in Nigerian populations has not been prospectively studied. This prospective longitudinal cohort study measures bone mineral density (BMD) changes and incident fracture rates over three years among HIV-positive adults initiating ART at the Jos University Teaching Hospital HIV treatment clinic and Federal Medical Centre Makurdi, North Central Nigeria. Two hundred HIV-positive adults initiating ART will be enrolled alongside 100 HIV-negative controls. Dual-energy X-ray absorptiometry (DEXA) of the lumbar spine and femoral neck will be performed at baseline, twelve, twenty-four, and thirty-six months. Serum bone turnover markers, CD4 count, viral load, vitamin D, and calcium levels will be measured at each time point. Incident fractures will be ascertained through clinical review and radiographic assessment. Linear mixed-effects models will characterise BMD change trajectories and Cox regression will model fracture incidence. The study hypothesises that tenofovir-containing regimens are associated with significantly greater BMD decline than alternative ART regimens at twelve months. Findings will be submitted to the National Agency for the Control of AIDS (NACA) and published to inform ART regimen selection and bone health monitoring guidelines for HIV-positive Nigerians. Keywords: antiretroviral therapy, bone mineral density, HIV, fracture incidence, North Central Nigeria.