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Bone health in HIV-infected children on antiretroviral therapy: An Indian study
Shruti Bhise1, Ashish Jain2, Lalita Savardekar2
1Department of Pediatrics, Pediatric HIV Clinic, B J Wadia Hospital for Children, Mumbai, Maharashtra, India.
Insights
Nearly all HIV-infected children on antiretroviral therapy (ART) have low vitamin D levels, impacting bone mineral density (BMD). Shorter ART duration was linked to lower BMD, highlighting the need for monitoring bone health in pediatric HIV patients.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Bone Metabolism
Background:
- Antiretroviral therapy (ART) is crucial for managing HIV infection in children.
- Bone health complications are increasingly recognized in children with HIV.
- The impact of ART on bone mineral density (BMD) in pediatric populations requires further investigation.
Purpose of the Study:
- To assess bone health, including BMD and key biochemical markers, in HIV-infected children receiving ART.
- To identify factors associated with low BMD in this cohort.
Main Methods:
- Cross-sectional study of 31 HIV-infected children (aged 5-18 years).
- Assessment of serum calcium, phosphorous, alkaline phosphatase, and 25(OH) Vitamin D.
- Bone mineral density (BMD) measurement using DXA scans for lumbar spine and femoral neck.
- Analysis of factors associated with low BMD, including ART duration.
Main Results:
- A significant proportion of children exhibited low spinal (22.6%) and femoral neck (19.4%) BMD.
- Over 96% of participants had low 25(OH) Vitamin D levels.
- Lower BMD was associated with shorter duration of ART and lower mean 25(OH) Vitamin D levels.
Conclusions:
- Low 25(OH) Vitamin D is highly prevalent in HIV-infected children on ART and is linked to reduced appendicular BMD.
- Bone mineral density may be more compromised in children with shorter ART exposure.
- No specific ART regimen was found to be associated with low BMD, suggesting a broader impact of HIV and its treatment on bone health.
Aim:
The aim of this study is to determine the bone health in HIV-infected children on antiretroviral therapy (ART).
Materials And Methods:
This cross-sectional study was carried out in 31 HIV-infected children aged 5-18 years. Each patient underwent testing for serum calcium, phosphorous, alkaline phosphatase, and 25(OH) Vitamin D. Bone mineral density (BMD) was done using a DXA scanner. Patients' z scores for BMD of the lumbar spine and left femoral neck were noted. The factors associated with low BMD were analyzed.
Results:
Seven (22.6%) children had a low spinal BMD and 6 (19.4%) had low femoral neck BMD. Low serum calcium was seen in 6 (19.4%) patients and high alkaline phosphatase was seen in 15 (48.4%) patients. Low serum 25 (OH) Vitamin D levels were present in 30 (96.8%) patients, whereas all the patients had normal serum phosphorous. Duration of ART in those with low spinal BMD was 4.6 ± 3.4 years as compared to 6.4 ± 3.2 years in those with normal spinal BMD (P = 0.235) and for low left femoral neck BMD was 3.9 ± 2 years as compared to 6.5 ± 3.4 years for those with normal femoral neck BMD (P = 0.031). Mean 25(OH) Vitamin D levels were 8.4 ± 2.8 ng/ml in those with low femoral neck BMD as compared to 13.6 ± 8.3 ng/ml in those with normal femoral neck BMD (P = 0.015). Type of ART did not have any association with low BMD.
Conclusion:
Over 95% of HIV-infected children have low 25(OH) Vitamin D levels which affect the appendicular BMD. BMD is affected more in children who have been on ART for a shorter time. No particular ART regimen is associated with low BMD.
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