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Altered bone metabolism in children infected with human immunodeficiency virus
G Zamboni1, F Antoniazzi, F Bertoldo
1Pediatric Clinic, University of Verona, Verona, Italy. Giorgio.Zamboni@univr.it
Insights
Low osteocalcin levels in children with human immunodeficiency virus (HIV) may signal bone metabolism changes. Significant bone loss is detectable by bone densitometry only when the immune system is severely compromised.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Bone Metabolism
Background:
- Bone homeostasis data in vertically HIV-infected children during peak bone mass acquisition is scarce.
- Understanding bone metabolism alterations is crucial for managing long-term health in pediatric HIV.
Purpose of the Study:
- To investigate potential alterations in bone metabolism in prepubertal children with vertically acquired HIV.
- To correlate biochemical markers with bone mineral density in this population.
Main Methods:
- Assessed viral load, CD4 counts, IL-6, IGF-I, IGFBP-3, ALS, and IGFBP-3 proteolysis.
- Measured serum osteocalcin and urinary N-terminal telopeptide of type I collagen.
- Evaluated lumbar spine bone mineral density using dual-energy X-ray absorptiometry.
Main Results:
- All patients exhibited low osteocalcin levels.
- Six children with low CD4 counts and high IL-6 showed low IGF-I and decreased bone mineral density.
- Normal IGFBP-3, ALS, and absent IGFBP-3 proteolysis were observed in those with low IGF-I.
Conclusions:
- Low serum osteocalcin may serve as an early indicator of altered bone metabolism in HIV-infected children.
- Measurable bone loss via densitometry is associated with significant immune compromise.
Aim:
Data on bone homoeostasis of children infected with human immunodeficiency virus (HIV), at the time of the gain in bone mass, are very rare. To determine possible alterations in bone metabolism, 13 prepubertal vertically HIV-infected children were studied.
Methods:
Viral load, CD4 count, interleukin-6 (IL-6), growth hormone, insulin-like growth factor-I (IGF-I), IGF binding protein-3 (IGFBP-3), acid-labile subunit (ALS), IGFBP-3 proteolysis, osteocalcin in blood and N-terminal telopeptide of type I collagen in urine were determined. Lumbar spine bone mineral density was examined by dual-energy X-ray absorptiometry.
Results:
Low osteocalcin levels were found in all patients. Low IGF-I was found in only six children, who had low CD4 count and high IL-6 levels, with normal levels of IGFBP-3 and ALS, absent IGFBP-3 proteolysis and decreased bone mineral density, irrespective of viral load or growth.
Conclusion:
Low serum osteocalcin levels appear to be an initial warning sign of possible altered bone metabolism in HIV-infected children. However, only when the immune system becomes more seriously compromised is bone loss measurable by bone densitometry.