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.
aSection of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
bCenter for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
cPediatric Adolescent Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
dDivision of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine at the University of Miami, Miami, Florida
eSaban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
fNew York University Langone Medical Center, New York, New York
gDepartment of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
hFrontier Science and Technology Research Foundation, Amherst, New York
iDepartment of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
jDepartment of Pediatrics, Tulane University Health Sciences Center, New Orleans, Los Angeles
kBody Composition Analysis Center, Friedman School of Nutrition Science and Policy, Tufts University
lDepartment of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
Correspondence to Linda DiMeglio, MD, MPH, Room 5960, 705 Riley Hospital Drive, Indianapolis, IN 46202-5225, USA. E-mail: firstname.lastname@example.org
Received 3 May, 2012
Revised 26 July, 2012
Accepted 20 September, 2012