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Endocrine function in thai children infected with human immunodeficiency virus
Ouyporn Panamonta1, Pope Kosalaraksa, Bandit Thinkhamrop
1Department of Pediatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. ouypan@kku.ac.th
Insights
HIV-infected children often exhibit endocrine dysfunction, impacting growth. This study found that severe immune suppression and growth failure in these children correlate with abnormal endocrine function, especially concerning insulin-like growth factor-I (IGF-I) levels.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Children with Human Immunodeficiency Virus (HIV) infection frequently present with symptoms resembling endocrine dysfunction, including growth impairment and hyperpigmentation.
- Assessing endocrine function is crucial for managing pediatric HIV, as it impacts overall health and development.
Purpose of the Study:
- To evaluate the endocrine function in Thai children infected with HIV.
- To investigate the relationship between HIV disease severity, height, and endocrine function in this pediatric population.
Main Methods:
- A cross-sectional study involving 36 prepubertal children with HIV (aged 4-12 years).
- Endocrine assessments included thyroid function tests (T4, T3, TSH, free T4), morning serum cortisol, serum insulin-like growth factor-I (IGF-I), and IGF binding protein-3 (IGFBP-3).
- Disease severity was determined by CD4+ T-lymphocyte percentage; height was assessed using standard deviation scores (SDS).
Main Results:
- Abnormal thyroid function was observed in 10 (28%) patients, including euthyroid sick syndrome and compensated hypothyroidism.
- A significant proportion of patients exhibited low IGF-I (two-thirds) and IGFBP-3 (one-third) standard deviation scores (SDS).
- Seventy-two percent of patients were severely immune suppressed (CD4+ <15%). Weak correlations were found between disease severity and endocrine function, with significant associations noted for IGF-I, IGFBP-3, T3, and free T4.
- Nearly half (44%) of the children were below the third percentile for height, with significant correlations between height SDS and IGF-I SDS, T3, and TSH.
Conclusions:
- HIV-infected children experiencing growth failure and advanced disease are more likely to have abnormal endocrine function.
- Disordered insulin-like growth factor-I (IGF-I) levels are particularly prevalent in this vulnerable group.
- These findings highlight the importance of monitoring endocrine health in pediatric HIV management, especially in cases of growth impairment and severe immunosuppression.
Abstract:
Most children infected by HIV show manifestations which mimic the clinical features of endocrine dysfunction, such as failure to thrive and hyperpigmentation. Our cross-sectional study was designed to assess the endocrine function of Thai children infected with HIV and to determine any relationship between disease severity, height and endocrine function. Thirty-six prepubertal children infected by HIV, 12 boys and 24 girls, aged 4-12 years (mean +/- SD 7 +/- 2 years), were tested for thyroid function (serum T4, T3, TSH and free T4), morning serum cortisol level, serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3). Disease severity was assessed using CD4+ T-lymphocyte percentage. Ten (28%) patients showed abnormal thyroid function. Five patients had euthyroid sick syndrome. Thyroid function tests indicated another five patients had a condition compatible with compensated hypothyroidism. Most patients had normal morning serum cortisol levels. Two-thirds and one-third of the patients showed low IGF-I and IGFBP-3 standard deviation scores (SDS), respectively. Twenty-six (72%) patients had CD4+ T-lymphocyte <15%, thus were classified as severely immune suppressed. A weak linear relationship was indicated between disease severity and endocrine function (r = -0.03 to 0.41). Statistical significance was found between CD4+ percentage and IGF-I SDS, IGFBP-3 SDS, serum T3 and free T4 (p-value = 0.03, 0.02, 0.02 and 0.01, respectively. Nearly half (44%) the patients were below the third percentile for height of Thai children. There was also a weak correlation between height SDS and endocrine function (r = -0.03 to 0.41). Statistical significance was observed between height SDS and IGF-I SDS, serum T3 and TSH (p-value = 0.02 and 0.01, respectively). We conclude that HIV-infected children with demonstrated growth failure and greater disease severity tend to have abnormal endocrine function, particularly disordered IGF-I levels.
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