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Puberty in perinatal HIV-1 infection: a multicentre longitudinal study of 212 children
M de Martino1, P A Tovo, L Galli
1Department of Paediatrics, University of Florence, Florence, Italy.
Insights
Children with perinatal HIV-1 infection experience delayed sexual maturation. This study defines the age of entry into Tanner stages for these children, highlighting a significant delay compared to healthy peers.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Human Development
Background:
- Perinatal HIV-1 infection can impact child development.
- Understanding the timing of sexual maturation in these children is crucial for their overall health and well-being.
Purpose of the Study:
- To determine the age of entry into Tanner stages of puberty for children with perinatal Human Immunodeficiency Virus type 1 (HIV-1) infection.
- To compare these timings with healthy children to quantify any delays.
Main Methods:
- A multicentre longitudinal study followed 212 children with perinatal HIV-1 infection through puberty.
- Kaplan-Meier product-limit method was used to estimate cumulative probabilities of entering each Tanner stage.
- Healthy children (n=1664) provided reference percentile data.
Main Results:
- Girls with perinatal HIV-1 infection showed a significant delay in entering pubertal stages (P2-P4, B2-B4), with ages exceeding the 97th percentile of controls (≥ 21-month delay).
- Boys with perinatal HIV-1 infection also experienced delays, with ages at pubertal stages (P2-P4, G2-G4) falling between the 75th and 97th percentiles of controls (≤ 15-month delay).
- The age of pubertal onset was not correlated with clinical status, immunological condition, antiretroviral therapy, or disease severity.
Conclusions:
- Perinatal HIV-1 infection significantly interferes with the timing of sexual maturation.
- Further research is needed to elucidate the mechanisms behind this delay and to develop effective intervention strategies.
- Addressing these pubertal delays may alleviate psychological distress in adolescents affected by HIV-1, especially when associated with growth failure.
Objective:
To define age at entry into Tanner stages in children with perinatal HIV-1 infection.
Design:
Multicentre longitudinal study including 212 perinatally HIV-1-infected children (107 girls and 105 boys) followed-up during puberty (from 8 and 9 years onwards in girls and boys, respectively). Healthy children (843 girls and 821 boys) provided reference percentiles. P2 or B2 stages in girls and P2 or G2 stages in boys defined onset of puberty.
Methods:
The cumulative probability [95% confidence limit (CI)] of entry into each stage at different ages was estimated by the Kaplan-Meier product-limit method; differences were evaluated by log rank test. Relationships were tested using the Spearman's rank correlation coefficient.
Results:
Ages of girls [years (95%CI)] at P2 [12.9 (12.6-13.2)], P3 [13.4 (13.0-13.8)], P4 [14.6 (14.0-15.2)], B2 [12.7 (12.2-13.2)], B3 [13.3 (12.8-14.0)] and B4 [14.6 (14.0-15.2)] stages were > 97th percentile (> or = 21 month delay) of controls. Ages of boys [years (95%CI)] at P2 [12.6 (12.1-13.1)], P3 [13.9 (13.4-14.4)], P4 [14.9 (14.2-15.6)], G2 [12.1 (11.5-12.7)], G3 [13.6 (13.1-14.1)] and G4 [14.9 (14.1-15.7)] stages were at the 75-97th percentiles (< or = 15 month delay). Age at onset of puberty was not related to clinical and immunological condition, antiretroviral treatment, weigh for height and age at onset of severe disease or immune suppression.
Conclusion:
Perinatal HIV-1 infection interferes with sexual maturation. The mechanisms by which this occurs should be elucidated and intervention strategies designed. Intervention could save much psychological distress, since associated linear growth failure can exacerbate adolescents' feelings of being different and unwell.
