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Published on: January 29, 2018
Bone mineral density in children and adolescents with perinatal HIV infection
Linda A DiMeglio1, JiaJia Wang, George K Siberry
1Section of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA. dimeglio@iupui.edu
Insights
Children with perinatally acquired human immunodeficiency virus (HIV) infection have lower bone mineral density (BMD) than their uninfected peers. Prepubertal factors may impact adult bone health in these children.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Bone Metabolism
Background:
- Children with perinatally acquired HIV infection (HIV+) often experience growth delays and altered body composition.
- Bone mineral density (BMD) is crucial for skeletal health and fracture prevention, particularly during childhood and adolescence.
Purpose of the Study:
- To determine the prevalence of low bone mineral density (BMD) in perinatally HIV-infected (HIV+) children and HIV-exposed but uninfected (HEU) children.
- To identify predictors of BMD in HIV+ children.
Main Methods:
- A cross-sectional analysis was conducted on 350 HIV+ and 160 HEU children across 15 US and Puerto Rico sites.
- Dual-energy X-ray absorptiometry measured total body and lumbar spine BMD, with Z-scores adjusted for bone age and sex.
- Multiple linear regression analyzed BMD differences by HIV status and identified predictors in HIV+ children.
Main Results:
- HIV+ children had a higher prevalence of low total body and lumbar spine BMD Z-scores (< -2.0) compared to HEU children.
- Differences in BMD Z-scores between groups were partially explained by height and weight adjustments.
- In HIV+ children, lower total body BMD Z-scores were associated with higher CD4% and use of boosted protease inhibitors or lamivudine; lower lumbar spine BMD Z-scores were linked to higher peak viral load, CD4%, longer duration of HAART, and indinavir use.
Conclusions:
- HIV+ children exhibited higher rates of low BMD than expected, partly due to growth delays.
- As most HIV+ children were prepubertal, early life factors influencing BMD may have lasting effects on peak bone mass in adulthood.
- Early identification and management of factors affecting bone health are critical for optimizing long-term skeletal outcomes in HIV-infected children.
Objective:
To estimate prevalence of low bone mineral density (BMD) in perinatally HIV-infected (HIV+) and HIV-exposed but uninfected (HEU) children, and to determine predictors of BMD in HIV+.
Design:
Cross-sectional analysis within a 15-site United States and Puerto Rico cohort study.
Methods:
Total body and lumbar spine BMD were measured using dual energy-X-ray absorptiometry. BMD Z-scores accounted for bone age and sex. Multiple linear regression was used to evaluate differences in Z-scores by HIV status and for predictors of BMD in HIV+.
Results:
350 HIV+ and 160 HEU were enrolled. Mean age was 12.6 and 10.7 years for HIV+ and HEU, respectively. Most (87%) HIV+ were receiving HAART. More HIV+ than HEU had total body and lumbar spine Z-scores less than -2.0 (total body: 7 vs. 1%, P = 0.008; lumbar spine: 4 vs. 1%, P = 0.08). Average differences in Z-scores between HIV+ and HEU were attenuated after height and/or weight adjustment. Among HIV+, total body Z-scores were lower in those with higher CD4% and in those who ever used boosted protease inhibitors or lamivudine. Lumbar spine Z-scores were lower with higher peak viral load and CD4%, more years on HAART, and ever use of indinavir.
Conclusion:
Rates of low BMD in HIV+ children were greater than expected based on normal population distributions. These differences were partially explained by delays in growth. As most HIV+ children in this study had not entered their pubertal growth spurt, prepubertal factors associated with BMD, magnified or carried forward, may result in sub-optimal peak BMD in adulthood.
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