Shiau S, et al. - Experts assessed the association between immune activation, bone turnover, and bone mass in a group of pre-pubertal HIV-infected children randomized to remain on ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy (ART) or switch to efavirenz-based ART in South Africa. They noted that HIV-infected children had lower whole body (WB) bone mineral content (BMC) Z-scores, similar IL-6 and TNF-alpha, higher soluble CD14 and high-sensitivity C-reactive protein (CRP), and lower markers of bone resorption (CTX) and bone formation (P1NP) vs uninfected controls. In those remaining on LPV/r or switched to efavirenz, bone turnover markers were not different. Findings suggested that decreased bone accrual could occur or persist independent of immune activation and altered bone turnover.