Bone Health in HIV-Infected Children, Adolescents and Young Adults: A Systematic Review

Abstract

Background Children and adolescents, who either acquire HIV infection perinatally, from contaminated blood products or via sexual transmission early in life, have the greatest cumulative exposure to the negative direct and indirect effects of HIV infection and ART on bone, which may lead to increased lifetime risk for osteoporosis and fracture. We conducted a systematic review to evaluate the literature on bone health in children and adolescents with HIV. Methods We performed a comprehensive search of the Medline, Scopus, and Cochrane Library databases (up to April 1, 2014) for studies that reported on bone imaging or bone fractures in HIV-infected children, adolescents, or young adults. Results A total of 32 publications met our inclusion criteria. Seventeen studies were cross-sectional and 15 were longitudinal. The majority of studies were conducted in high-income countries, three in middle-income countries and none in low-income countries. Overall, the studies we reviewed indicate that measures of bone mass are reduced, with increased prevalence of low BMD in children and adolescents with HIV. However, the studies are highly variable with respect to comparison sources, measurement methods, adjustment techniques for body size or growth retardation, and highlighted risk factors, including aspects related to medication exposures as well as the effects of HIV infection per se. Conclusion HIV infection appears to be associated with decreased bone accrual throughout childhood and adolescence. Initial studies indicate that sub-optimal bone accrual may be persistent and result in reduced peak bone mass, an important determinant of future risk of osteoporosis and fracture. Important areas for future research include evaluation of bone mass, bone quality and fracture risk across the life course among those with early-life infection with HIV, particularly in resource-limited settings where the majority of children with HIV live.

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

“…However, there were no height differences between those with and without HIV in this study . To the best of our knowledge, the effect of BMD on growth among adolescents living in LMICs has not been explored .…”

Adverse bone health and abnormal bone turnover among perinatally HIV‐infected Asian adolescents with virological suppression

“…However, long‐term, non‐AIDS‐related complications associated with HIV infection and cART have been emerging . Adverse bone health is a specific concern in this population undergoing normal physical development . Low bone mass, evaluated by dual‐energy X‐ray absorptiometry (DXA), has been reported in HIV‐infected children and adolescents .…”

Prediction of Areal Bone Mineral Density and Bone Mineral Content in Children and Adolescents Living With HIV Based on Anthropometric Variables

“…The available information suggests low bone mineral content (BMC) and areal bone mineral density (aBMD) in children and adolescents infected with HIV (2). The main concern regarding seropositive individuals infected by vertical transmission are the long-term effects of exposure to HIV and to the drugs used for its treatment, particularly during puberty, a critical period of bone mineral accrual when about 80% of the adult bone mass is deposited.…”