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AIDS:
doi: 10.1097/QAD.0b013e32835a9b80
Clinical Science

Bone mineral density in children and adolescents with perinatal HIV infection

DiMeglio, Linda A.a; Wang, JiaJiab; Siberry, George K.c; Miller, Tracie L.d; Geffner, Mitchell E.e; Hazra, Rohanc; Borkowsky, Williamf; Chen, Janet S.g; Dooley, Laurieh; Patel, Kunjali; van Dyke, Russell B.j; Fielding, Roger A.k; Gurmu, Yaredl; Jacobson, Denise L.b; for the Pediatric HIVAIDS Cohort Study (PHACS)

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Abstract

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.

© 2013 Lippincott Williams & Wilkins, Inc.

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