Effect of HIV infection on growth and bone density in peripubertal children under antiretroviral therapy

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As reported in The Lancet Child and Adolescent Health 2021, a cross-sectional study from the IMVASK cohort enrolled and investigated human immunodeficiency virus (HIV)-infected children who were previously treated with antiretroviral therapy (ART) for at least 2 years, and were compared against children of the same age without HIV.

Dual-energy X-ray absorptiometry was used to measure the bone outcomes of total-body less-head bone mineral content for lean mass adjusted for height (TBLH-BMCLBM) and lumbar spine bone mineral apparent density (LS-BMAD), in order to assess the risk of low TBLH-BMCLBM and LS-BMAD defined by Z-scores less than –2.0.

A total of 609 children aged 8-16 years with 303 HIV-infected (mean age 12.4 years [SD 2.5]; 151 [50%] girls) and 306 HIV-uninfected (mean age 12.5 years [SD 2.5]; 155 [51%] girls) of similar demographics were evaluated. For those with HIV, median age of HIV diagnosis was 3.0 years (IQR 1.2–5.8), and median ART duration was 8.1 years (6.2–9.5). Tenofovir disoproxil fumarate (TDF) included ART was experienced by 102 (34%) children.

Children with HIV reported low TBLH-BMCLBM Z-score (10% vs. 6%; p=0.066) and low LS-BMAD Z-score (14% vs. 6%; p=0.0007) compared to those without HIV. TDF exposure was also associated with lower TBLH-BMCLBM Z-score in the confounder-adjusted analysis, a reduction of 0.41 (95% CI 0.08–0.74; p=0.015) in the TBLH-BMCLBM Z-score and 0.31 (0.08–0.69; p=0.12) in the LS-BMAD Z-score were observed in contrast to non-TDF-based ART.

In conclusion, HIV was found to be associated with a substantial skeletal deficit of 2 SDs or more from reference mean values despite the use of ART, particularly marked towards the end of puberty. Children with HIV had lower LS-BMAD Z-scores and a greater risk of low LS-BMAD than those without HIV. TDF-associated bone deficits in children remains a concern for future adult fracture risk.

Reference

Rukuni R, et al. Lancet Child Adolescent Health 2021; S2352-4642(21)00133-4

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