Background: Chronic diseases are the main causes of bone mass reduction in childhood and adolescence. Different aspects related to the process of bone acquisition and maintenance may be affected. Studies had point out the presence of bone mass reduction in children and adolescents with HIV infection with association to antiretroviral use, chronological age (CA), weight and serum CD4 T-cell counts. However, others do not.
Objective: To evaluate bone mineral density (BMD) in children and adolescents with vertically HIV infection and associated factors.
Methods: Observational study in 46 vertically HIV-infected children and adolescents aged 7.7±3.5 years (17 males). Age, sex, weight, height, CDC clinical categories, BMD at lumbar spine (DXA), blood calcium, phosphorus, alkaline phosphatase (AP), CD4 and CD8 T-cell counts, IGF1, viral load and uCa/Creat were evaluated. BMD, weight and height were expressed in z-score. Reduced BMD was defined as z-score <−2 DP. Linear regressions, MannWhitney U, KruskalWallis and Fisher tests were used in statistical analyses. Human Ethics Comity approved the study.
Results: Reduced bone mass occurred in 13.0%. These patients had higher CA (12.3 vs 7.5; P<0.01), AP (232.7 vs 165.4; P<0.01) and IGF1 (464.8 vs 195.4; P<0.01); and lower CD4 (356.8 vs 761.8; P<0.01) and uCa/Creat (0.1 vs 0.6; P<0.01). BMD correlated positively with CD4 and negatively with CA and IGF1. In multivariate analysis BMD correlated with CD4, CA, AP, uCa/Creat and IGF1 (r=0.950; P<0.001). Adolescents had higher proportion of reduced BMD (66.7% adolescents (1019 years) vs 33.3% schoolers (610 years); P<0.01) and lower BMD (−1.91 adolescents vs −1.11 schoolers vs −0.31 preschoolers (25 years); P<0.001).
Conclusion: Vertical HIV infection are associated with reduced bone mass, especially during adolescence. The association of low bone mass to low CD4 and higher CA suggests that duration of infection and clinical conditions affects bone mineral acquisition in this group.
Funding: This work was supported by CNPq and FURB research grants (PIBIC CNPq and PIBIC FURB).
01 - 03 Oct 2015
European Society for Paediatric Endocrinology