Background
Low bone mineral density (BMD) has been reported among 10–54% of HIV-infected adolescents in developed countries. We studied the prevalence and predictors of low BMD among HIV-infected Thai adolescents receiving antiretroviral therapy.
Methods
A cross-sectional study of lumbar spine (L2–L4) BMD as measured by dual-energy X-ray absorptiometry (DXA) in Thai HIV-infected adolescents aged 12–20 years was performed. The BMD Z-score was analyzed using age-matched healthy Thai children as a reference. Serum 25-hydroxyvitamin D (25-OHD) was performed. Osteopenia was defined as BMD Z-score≤ −2.
Results
From October 2010 to February 2011, 101 adolescents, 50% male, with a median age of 14.3 (range, 13.0–15.7) years were enrolled. The median (IQR) current CD4 T-cell count was 646 (506–796) cells/mm3 and 90% had plasma HIV-1 RNA <50 copies/ml. The mean BMD among HIV-infected adolescents and controls were 0.855 and 0.980 g/cm2(P<0.001). The median (IQR) L2–L4 spine BMD Z-score was −1.0 (−1.9 to −0.1), of which 24% had BMD Z-score ≤ −2.0. The median (IQR) of 25-OHD level was 24.8 (20.0–31.4) ng/ml, of which 25% had vitamin D level < 20 ng/ml. In multivariate analysis, the height for age Z-score <−1.5 (adjusted odds ratio (aOR) 6.2; 95% CI 2.2–17.7) and history of WHO clinical stage 4 prior to ART (aOR 3.7; 95%CI 1.3–10.7) were significantly associated with osteopenia.
Conclusion
One-fourth of HIV-infected Thai adolescents have osteopenia. Children with history of advanced- staging or having low height for age are at risk of osteopenia. Preventive measures to prevent osteopenia should be incorporated in routine care for these adolescents.