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Bone health in children and adolescents with perinatal HIV infection
Thanyawee Puthanakit1, George K Siberry
1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Lifelong HIV infection and ART may impact bone health in children. More research is needed to understand bone mineral density (BMD) and fracture risks in youth with HIV.
Area of Science:
- Pediatric Bone Health
- HIV/AIDS Research
- Pharmacology
Background:
- Long-term effects of HIV and antiretroviral therapy (ART) on bone health in children are unknown.
- Bone health in youth requires interpretation considering developmental changes.
- Low bone mineral density (BMD) is common in perinatally HIV-infected youth, particularly in low-income settings.
Purpose of the Study:
- To review the current understanding of bone health in children with lifelong HIV infection.
- To highlight concerns regarding tenofovir's potential impact on BMD and bone mass accrual.
- To identify strategies for maintaining bone health and areas for future research.
Main Methods:
- Literature review and synthesis of existing data on HIV, ART, and pediatric bone health.
- Analysis of factors influencing bone development in HIV-infected youth.
- Discussion of nutritional, lifestyle, and pharmacological considerations.
Main Results:
- Limited data suggest low BMD is prevalent in HIV-infected youth.
- Tenofovir raises concerns for potential negative effects on bone accrual.
- Current data on fracture risk in this population are very limited.
Conclusions:
- HIV-infected youth may not achieve optimal peak bone mass, increasing future osteoporosis and fracture risk.
- Good nutrition, vitamin D, calcium, exercise, and avoidance of alcohol/smoking are crucial.
- Further research is essential to guide therapies and monitoring for bone fragility in HIV-infected youth.
Abstract:
The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.
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