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Published on: January 5, 2016
Endocrine abnormalities and impaired growth in human immunodeficiency virus-infected children
Caroline J Chantry1, Margaret M Frederick, William A Meyer
1University of California, Davis, Medical Center, Sacramento, CA 95817, USA. caroline.chantry@ucdmc.ucdavis.edu
Insights
Human immunodeficiency virus (HIV)-infected children show lower insulin-like growth factor binding protein-3 (IGFBP-3) levels. Endocrine differences in HIV-infected children impact growth and body composition.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Growth and Development
Background:
- Human immunodeficiency virus (HIV) infection can affect multiple organ systems, including endocrine function.
- Understanding endocrine differences in HIV-infected children is crucial for managing their growth and body composition.
Purpose of the Study:
- To identify endocrine differences between HIV-infected and uninfected children.
- To evaluate the associations of growth and body composition with endocrine measures in these children.
Main Methods:
- A nested case-control study compared 21 HIV-infected children with 46 age- and sex-matched uninfected children.
- Plasma levels of IGFBP-3, cortisol, DHEA, growth hormone, and thyroid hormones were measured.
- Longitudinal models analyzed group differences and endocrine associations with growth and body composition.
Main Results:
- HIV-infected children had significantly lower IGFBP-3 concentrations compared to uninfected children.
- In HIV-infected children, IGFBP-3 and dehydroepiandrosterone (DHEA) to cortisol ratios were associated with weight-for-age z scores (WAZ) and body mass index z scores (BMZ).
- DHEA concentration was associated with height-for-age z score.
Conclusions:
- HIV infection is associated with altered IGFBP-3 concentrations in children.
- Endocrine factors show distinct associations with growth and body composition in HIV-infected children compared to their uninfected peers.
- Hypothesized growth hormone resistance and altered adrenal androgen production may contribute to growth abnormalities in HIV-infected children.
Objectives:
Identify endocrine differences between human immunodeficiency virus- (HIV) infected versus uninfected children and evaluate associations of growth and body composition with endocrine measures.
Study Design:
Nested case-control study in 21 HIV-infected and 46 age- and sex-matched uninfected children in the Women and Infant Transmission Study. Plasma specimens from children between 2.5 to 7.0 years of age, taken during 3-4 visits, were tested for insulin-like growth factor binding protein-3 (IGFBP-3), cortisol, dehydroepiandrosterone (DHEA), growth hormone and thyroid studies. Longitudinal mixed and generalized estimating equation models compared group means and examined effects of endocrine measures on growth and body composition, respectively.
Results:
HIV-infected children had lower IGFBP-3 than uninfected children (1.96 +/- 0.09 mg/L versus 2.34 +/- 0.06 mg/L, P < 0.001). In infected but not in uninfected children, IGFBP-3 values and DHEA:cortisol ratios were associated with weight- and body mass index-for-age z scores ([WAZ] P = 0.019, <.001 respectively, and [BMZ] P = 0.029, 0.038). DHEA concentration was associated with height-for-age z score (P = 0.049).
Conclusions:
In these HIV-infected children compared with their uninfected counterparts, IGFBP-3 concentration was different between groups. Infected children had multiple endocrine associations with growth and body composition not found in their uninfected peers. We hypothesize that in HIV-infected children, growth hormone resistance and shunting of precursors from adrenal androgen to cortisol production contributes to altered body composition and stunting.
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