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Bone mineral content in girls perinatally infected with HIV
K O O'Brien1, M Razavi, R A Henderson
1Johns Hopkins University Center for Human Nutrition, School of Hygiene and Public Health, Baltimore, MD 21205-2179, USA. kobrien@jhsph.edu
Insights
Children with HIV infection show low bone mass and calcium insufficiency. Nutritional guidance should focus on adequate calcium intake for optimal bone health during this critical growth period.
Area of Science:
- Pediatric Endocrinology
- Nutritional Science
- Bone Metabolism
Background:
- Advances in multidrug therapy have increased survival for children with perinatal HIV infection.
- However, research on calcium status and bone growth in this population remains limited.
Purpose of the Study:
- To investigate the impact of HIV infection on calcium status and bone growth in children.
- Specifically examining calcitropic hormones, calcium excretion, and bone mineral content.
Main Methods:
- Assessed 19 perinatally HIV-infected girls (mean age 9.2 years).
- Measured serum calcitropic hormones (e.g., 1,25-dihydroxyvitamin D, parathyroid hormone).
- Evaluated urinary calcium excretion, bone mineral content (dual-energy X-ray absorptiometry), and body composition.
Main Results:
- Elevated 1,25-dihydroxyvitamin D and parathyroid hormone levels were observed in 25% and 12% of girls, respectively.
- 17% exhibited elevated urinary calcium excretion despite suboptimal calcium intake (679 mg/d).
- Total-body bone mineral content was significantly lower (2.7 z scores below controls), with correlations suggesting increased bone resorption linked to calcium insufficiency.
Conclusions:
- Young girls with HIV infection present with low bone mass and indicators of calcium insufficiency.
- Emphasizing adequate calcium intake through nutritional counseling is crucial for bone mineral acquisition in these children.
Background:
Early diagnostic efforts and advances in multidrug therapy have considerably prolonged the survival time of children infected perinatally with HIV. Despite these advances, few studies have addressed calcium status and bone growth in HIV-infected children.
Objective:
Our objective was to examine the effect of HIV infection on calcium status and bone growth in children.
Design:
We measured calcitropic hormones, urinary calcium excretion, bone mineral content, and body composition in 19 young girls aged 9.2 +/- 2.6 y (range: 5.9-15.2 y) who were infected perinatally with HIV.
Results:
Serum concentrations of 1,25-dihydroxyvitamin D [1,25(OH)(2)D] and parathyroid hormone concentrations were elevated above normal ranges in 25% and 12% of these girls, respectively. Urinary calcium excretion normalized for creatinine excretion was also elevated (Ca/Cr >0.18) in 17% of these children despite suboptimal calcium intakes (679 +/- 437 mg/d). Total-body bone mineral content, measured with the use of dual-energy X-ray absorptiometry, averaged 845.1 +/- 279.0 g and was on average 2.7 z scores below age- and race-matched values reported in non-HIV-infected healthy girls. Significant positive correlations were found between an indirect marker of bone resorption in urine (N:-telopeptide) and 1,25(OH)2D (P < 0.02, r2 = 0.586, n = 9), and between serum N-telopeptide and total alkaline phosphatase (P < 0.001, r2 = 0.541, n = 17), suggesting that calcium insufficiency may be increasing bone resorption in this group.
Conclusions:
Young girls with HIV infection had low bone mass and evidence of calcium insufficiency. Nutritional counseling of children with HIV infection should emphasize adequate calcium intakes because of the importance of this age period in bone mineral acquisition.