Of the 2 million children with HIV (CWH) globally, 90% live in sub-Saharan Africa (SSA). The scale-up of antiretroviral therapy (ART) has improved survival so that CWH are now increasingly reaching adolescence. However, childhood HIV infection is associated with a heavy burden of comorbidities, which have received little focus. Growth failure is one of the most common manifestations of HIV infection and is associated with impaired skeletal development.

 

The purpose of this trial is to establish whether supplementation with vitamin D and calcium optimises musculoskeletal health among peripubertal CWH in Harare and Lusaka. Puberty is a period of rapid growth and musculoskeletal development, culminating in the achievement of peak bone mass (PBM), a key determinant of future lifetime fracture risk, and peak muscle mass, a key determinant of age-related sarcopenia. If effective, it is anticipated that intervention during this critical period of growth will optimise bone accrual, conferring a reduction in future adult fracture risk. The intervention may have more immediate benefits: improving growth, muscle strength and immune function will improve overall physical and mental health and consequently social inclusion, enabling CWH to participate more in schooling, sports and social activities may further benefit their physical and mental health.