{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T02:43:57Z","timestamp":1782182637140,"version":"3.54.5"},"reference-count":61,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T00:00:00Z","timestamp":1581033600000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,1,2]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Children with (n=300) and without HIV (n=300), aged 8\u201316 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1\u2009year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores &lt;\u22122) will also be determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-031792","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T04:35:24Z","timestamp":1581309324000},"page":"e031792","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe (IMVASK Study): a protocol for a prospective cohort study"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"isrctn12266984","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2111-1311","authenticated-orcid":false,"given":"Ruramayi","family":"Rukuni","sequence":"first","affiliation":[{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Biomedical Research and Training Institute, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Gregson","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Unit, University of Bristol, Bristol, UK"},{"name":"Older Person's Unit, Royal United Hospital NHS Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Kahari","sequence":"additional","affiliation":[{"name":"Biomedical Research and Training Institute, Harare, Zimbabwe"},{"name":"Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farirayi","family":"Kowo","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Zimbabwe, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"McHugh","sequence":"additional","affiliation":[{"name":"Biomedical Research and Training Institute, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shungu","family":"Munyati","sequence":"additional","affiliation":[{"name":"Biomedical Research and Training Institute, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilda","family":"Mujuru","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Ward","sequence":"additional","affiliation":[{"name":"Lifecourse Epidemiology Unit, MRC, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Filteau","sequence":"additional","affiliation":[{"name":"Population Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9967-5822","authenticated-orcid":false,"given":"Andrea M","family":"Rehman","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashida","family":"Ferrand","sequence":"additional","affiliation":[{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,9]]},"reference":[{"key":"2025121410294711000_10.2.e031792.1","unstructured":"UNICEF: monitoring the situation of children and women; global and regional trends, current status and progress, 2017. 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