However, most other studies have also recruited HIV-positive subjects in a similar manner and this is unlikely to account for the different findings in our study. The rates of combined overweight and obesity 65 % in HIV-negative and non-ARV subjects in this study were greater than the national average in South Africa of 51.5 % [26]; even women with advanced HIV-disease (pre-ARV group) had a combined overweight and obesity rate of 44 %. It is possible, therefore, that the typically high weight of South African women has a sparing effect on bone in those with HIV infection, even with CD4 counts below the threshold for initiation of ARV intervention. Historically, being overweight

has been viewed as protective against osteoporotic fracture, although evidence is emerging that overweight selleck chemical and obesity may be a risk factor for leg fragility fractures in women [27]. In the study population of younger black women in South Africa, there were no significant differences in BMD SD score, expressed relative to the HIV-negative group, according to HIV status at any site. The effects of HIV and its treatment on fracture risk in South Africa are unknown. The lack of difference between

the groups which is at variance from previously reported studies may be the result of true lack of Atezolizumab mouse effect of HIV infection or reflect important differences in bone response to HIV between black Africans and Caucasians. The study design in which two distinct groups

of HIV-positive women, based on South African eligibility criteria for ARV treatment plus Adenylyl cyclase the inclusion of a HIV-negative control group strengthens the finding that HIV infection with varying degree of immunosuppression does not appear to be driving alterations in BMD or vitamin D status in these young, urban women. The high rates of overweight may be masking more dramatic differences in BMD and vitamin D in those subjects with advanced clinical HIV disease not included in this study. Further work is required to address the effects of ARV exposure on bone and vitamin D status as well as the relative effect of ‘traditional’ osteoporosis risk factors in this population. The data from this study provide an insight into bone health, body composition and vitamin D status in African women living with HIV. They challenge our own hypotheses and previously reported differences in BMD and vitamin D status in HIV-positive subjects living in developed countries and highlight the importance of studying subjects prior to ARV exposure. Acknowledgments We wish to acknowledge all of the study participants, staff at DPHRU, ZAZI/PHRU, Nthabiseng and Lilian Ngoyi clinics, Johannesburg SA. All authors contributed to interpretation and the writing of the manuscript. All authors had full access to the data.