Prevalence and Risk Factors of Low Bone Mineral Density Among Perinatally HIV-Infected Thai Adolescents Receiving Antiretroviral Therapy

Abstract

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.

Efavirenz is associated with higher bone mass in South African children with HIV

“…Multiple studies report reduced bone mass accrual among children and adolescents with HIV compared to HIV-uninfected children [14, 21, 58]. These studies have assessed bone mass accrual largely by DXA.…”

Prevalence of Vitamin D Deficiency Among Perinatally HIV-infected Thai Adolescents Receiving Antiretroviral Therapy

“…7 Subjects were evaluated for general clinical condition, tested for serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), calcium, and underwent BMD measurement by dual-energy X-ray absorptiometry (DXA). The 25(OH)D level and PTH were measured by chemiluminescent microparticle immunoassay (ARCHITECT 25-OH vitamin D assay and ARCHITECT Intact PTH assay, Abbott Diagnostics Division, Wiesbaden, Germany).…”

Review of Tenofovir Use in HIV-infected Children

“…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.…”