Bone mineral density in children and adolescents with perinatal HIV infection
- 14 January 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 27 (2), 211-220
- https://doi.org/10.1097/qad.0b013e32835a9b80
Abstract
Objective: To estimate prevalence of low bone mineral density (BMD) in perinatally HIV-infected (HIV+) and HIV-exposed but uninfected (HEU) children, and to determine predictors of BMD in HIV+. Design: Cross-sectional analysis within a 15-site United States and Puerto Rico cohort study. Methods: Total body and lumbar spine BMD were measured using dual energy-X-ray absorptiometry. BMD Z-scores accounted for bone age and sex. Multiple linear regression was used to evaluate differences in Z-scores by HIV status and for predictors of BMD in HIV+. Results: 350 HIV+ and 160 HEU were enrolled. Mean age was 12.6 and 10.7 years for HIV+ and HEU, respectively. Most (87%) HIV+ were receiving HAART. More HIV+ than HEU had total body and lumbar spine Z-scores less than −2.0 (total body: 7 vs. 1%, P = 0.008; lumbar spine: 4 vs. 1%, P = 0.08). Average differences in Z-scores between HIV+ and HEU were attenuated after height and/or weight adjustment. Among HIV+, total body Z-scores were lower in those with higher CD4% and in those who ever used boosted protease inhibitors or lamivudine. Lumbar spine Z-scores were lower with higher peak viral load and CD4%, more years on HAART, and ever use of indinavir. Conclusion: Rates of low BMD in HIV+ children were greater than expected based on normal population distributions. These differences were partially explained by delays in growth. As most HIV+ children in this study had not entered their pubertal growth spurt, prepubertal factors associated with BMD, magnified or carried forward, may result in sub-optimal peak BMD in adulthood.Keywords
This publication has 29 references indexed in Scilit:
- Bone Disease in HIV Infection: A Practical Review and Recommendations for HIV Care ProvidersClinical Infectious Diseases, 2010
- Fracture Prevalence among Human Immunodeficiency Virus (HIV)-InfectedVersusNon-HIV-Infected Patients in a Large U.S. Healthcare SystemJournal of Clinical Endocrinology & Metabolism, 2008
- HIV‐1 triggers apoptosis in primary osteoblasts and HOBIT cells through TNFα activationJournal of Medical Virology, 2008
- Decreased Bone Mineral Density with Off-Label Use of Tenofovir in Children and Adolescents Infected with Human Immunodeficiency VirusThe Journal of Pediatrics, 2008
- Fracture Prediction and the Definition of Osteoporosis in Children and Adolescents: The ISCD 2007 Pediatric Official PositionsJournal of Clinical Densitometry, 2008
- Low Body Weight Mediates the Relationship between HIV Infection and Low Bone Mineral Density: A Meta-AnalysisJournal of Clinical Endocrinology & Metabolism, 2007
- Fragility fractures and bone mineral density in HIV positive women: a case-control population-based studyOsteoporosis International, 2007
- Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic reviewAIDS, 2006
- Interactions among human immunodeficiency virus (HIV)-1, interferon-γand receptor of activated NF-κB ligand (RANKL): implications for HIV pathogenesisClinical and Experimental Immunology, 2004
- Peak bone mineral accrual and age at menarche in adolescent girls: A 6-year longitudinal studyThe Journal of Pediatrics, 1998