Factors associated with low bone mineral density in a Brazilian cohort of vertically HIV-infected adolescents

Schtscherbyna, Annie; Pinheiro, Maria Fernanda Miguens Castelar; Mendonça, Laura Maria Carvalho de; Gouveia, Carla Maria Barroso; Luiz, Ronir Raggio; Machado, Elizabeth S.; Farias, Maria Lúcia Fleiuss

doi:10.1016/j.ijid.2012.07.019

Cited by 36 publications

(66 citation statements)

References 37 publications

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“…Most studies were conducted in high income countries, including the United States [6, 7, 21–32], Italy [33–44], Canada [45], and the Netherlands [46]. Three studies were reported from middle-income countries, including one from Thailand [47] and two from Brazil [48, 49]. One study was conducted in three countries: the United States, Brazil, and Panama [50].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies enrolled children known to be HIV-uninfected but exposed to HIV in utero as a control group [29, 30] and one study recruited HIV-uninfected siblings [24]. Other studies drew comparisons with a number of existing cross-sectional or longitudinal normative databases comprised of healthy children from single or multiple study sites [21–23, 26–28, 34, 45, 47] or provided by the densitometer manufacturer [24, 41, 43, 46, 48, 49]. Bone densitometry by DXA was the predominant method for evaluation.…”

Section: Resultsmentioning

confidence: 99%

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

Arpadi¹,

Shiau

Marx-Arpadi

et al. 2014

J AIDS Clin Res

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Arpadi¹,

Shiau

Marx-Arpadi

et al. 2014

J AIDS Clin Res

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“…In cross-sectional studies to assess bone mineral density among perinatally HIV-infected children and adolescents receiving ART, the reported prevalence rate of BMD z-score <−2 is in a range of 24-32%. [69][70][71][72] Longitudinal assessment of BMD show that the median BMD z-scores usually decline from baseline in the first 6-12 months after initiation of ART and then remain stable thereafter. 65,73 This is similar to reports from HIVinfected adults that the decrease in BMD was seen early during the first 48 weeks of therapy, and then stable up to 5 years of follow-up.…”

Section: Tdf Effect On Bone Mineral Densitymentioning

confidence: 99%

“…For example, the Brazilian study reported low calcium and vitamin D intake in 72.9% and 91.5% of HIV-infected children, respectively. 72 In summary, the adverse impact of TDF on bone is well documented but its clinical significance remains controversial. More long-term studies are needed to see whether any clinically significant events occur.…”

Section: Tdf Effect On Bone Mineral Densitymentioning

confidence: 99%

Review of Tenofovir Use in HIV-infected Children

Aurpibul

Puthanakit

2015

Pediatric Infectious Disease Journal

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Tenofovir disoproxil fumarate (TDF) is approved by the Food and Drug Administration for use in children ages 2 years and older and is recommended by the World Health Organization for use as a preferred first-line nucleotide reverse transcriptase inhibitor in adults and adolescents ages 10 years and older. The simplicity of once daily dosing, few metabolic side effects and efficacy against hepatitis B virus make TDF suitable for use in a large scale program. Unlike thymidine analoge nucleoside reverse transcriptase inhibitors (NRTIs); tenofovir does not induce multi-NRTI resistance mutations, so more NRTI options are available for future second-line-regimens. Fixed-dose combinations of TDF with other ARVs as a single tablet regimen are now widely available for adults and adolescents, but none are available for young children. Current information on TDF including the pharmacokinetics, safety and tolerability in children and adolescents was reviewed. A dosing regimen according to body-weight-band has been established for pediatric use. Safety concerns of TDF mainly relate to its effects on renal function and bone mineral density. Regular monitoring of renal function in high-risk patients, including those on other nephrotoxic drugs, may be warranted to detect adverse renal effects. Long-term-data on renal and bone outcomes among HIV-infected children is needed. Lessons learned from clinical studies will help clinicians balance the risks and benefits of TDF and design appropriate antiretroviral regimens for children in different circumstances.

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“…It is noteworthy that TDF is not unique in its ability to cause a reduction in BMD. HIV infection itself and many other antiretroviral drugs also cause a decline in BMD [51][52][53][54][55]. Vitamin D deficiency is common in children with HIV infection, and this may be an additional factor in the development of bone disease; supplementation may be required in some cases [40].…”

Section: Discussionmentioning

confidence: 99%

Renal and Bone Adverse Effects of a Tenofovir-Based Regimen in the Treatment of HIV-Infected Children: A Systematic Review

2015

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Factors associated with low bone mineral density in a Brazilian cohort of vertically HIV-infected adolescents

Cited by 36 publications

References 37 publications

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

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

Review of Tenofovir Use in HIV-infected Children

Renal and Bone Adverse Effects of a Tenofovir-Based Regimen in the Treatment of HIV-Infected Children: A Systematic Review

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