Bone Accrual Trajectories in Children and Adolescents with Perinatal HIV Infection

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM(2024)

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Abstract
Context Low bone mineral density (BMD) has been reported in children and adolescents living with perinatally acquired HIV (PHIV). Little is known about their bone accrual through puberty compared to an uninfected healthy cohort.Objective To compare bone accrual in PHIV and healthy children.Design PHIV children aged 7 to 16 years had dual-energy X-ray absorptiometry at entry, at 2 years, and then at least 2 years later. Bone accrual was compared to healthy children from the Bone Mineral Density in Childhood Study (BMDCS).Setting US academic clinical research centers.Patients 172 PHIV; 1321 BMDCS.Analysis We calculated height-adjusted whole-body and spine BMD and bone mineral content (BMC) Z-scores in PHIV using BMDCS reference curves. We fit piecewise weighted linear mixed effects models with change points at 11 and 15 years, adjusted for age, sex, race, height Z-score, and Tanner stage, to compare BMD and BMC Z-scores across actual age by cohort.Main Outcome Measure BMD/BMC Z-scores.Results Height-adjusted whole-body BMD and BMC Z-scores in PHIV were lower across age compared to BMDCS children. Spine BMD Z-score across age was higher in PHIV after height adjustment. Whole-body and spine bone area tended to be lower in PHIV children. PHIV children had slower accrual in whole-body and spine bone area before 14 years. After 15 years, bone area accruals were similar, as were height-adjusted spine BMC Z-scores, across age.Conclusion PHIV children had persistent deficits in all measures except height-adjusted spine BMD and BMC Z-scores. Data are needed on PHIV children followed to adulthood.
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HIV,bone,children,density,growth,trajectories
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要点】:该研究探讨了与未感染HIV的健康儿童相比,围产期HIV感染儿童和青少年的骨骼积累轨迹,发现PHIV儿童在除调整身高后的脊柱BMD和骨矿含量Z分数外的所有测量指标上存在持续性的缺陷。

方法】:研究采用分段加权线性混合效应模型,通过比较PHIV儿童和BMDCS健康儿童在7至16岁期间的两次或以上双能X射线吸收测定法测量的身高调整后的全身及脊柱BMD和骨矿含量Z分数,评估骨骼积累情况。

实验】:在172名PHIV儿童和1321名BMDCS儿童中进行了实验,通过计算Z分数并使用BMDCS参考曲线,发现PHIV儿童在14岁前全身和脊柱骨面积积累较慢,15岁后骨面积积累速度与健康儿童相似。