Browsing by Author "Pediatric HIV/AIDS Cohort Study"

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    Bone Mineral Density in Children and Adolescents with Perinatal HIV Infection
    (Wolters Kluwer, 2013) Dimeglio, Linda A.; Wang, JiaJia; Siberry, George K.; Miller, Tracie L.; Geffner, Mitchell E.; Hazra, Rohan; Borkowsky, William; Chen, Janet S.; Dooley, Laurie; Patel, Kunjal; Van Dyke, Russell B.; Fielding, Roger A.; Gurmu, Yared; Jacobson, Denise L.; Pediatric HIV/AIDS Cohort Study; Pediatrics, School of Medicine
    Objective: To estimate prevalence of low bone mineral density (BMD) in perinatally HIV-infected (HIV+) and HIV-exposed but uninfected (HEU) children, and to determine predictors of BMD in HIV+. Design: Cross-sectional analysis within a 15-site United States and Puerto Rico cohort study. Methods: Total body and lumbar spine BMD were measured using dual energy-X-ray absorptiometry. BMD Z-scores accounted for bone age and sex. Multiple linear regression was used to evaluate differences in Z-scores by HIV status and for predictors of BMD in HIV+. Results: 350 HIV+ and 160 HEU were enrolled. Mean age was 12.6 and 10.7 years for HIV+ and HEU, respectively. Most (87%) HIV+ were receiving HAART. More HIV+ than HEU had total body and lumbar spine Z-scores less than -2.0 (total body: 7 vs. 1%, P = 0.008; lumbar spine: 4 vs. 1%, P = 0.08). Average differences in Z-scores between HIV+ and HEU were attenuated after height and/or weight adjustment. Among HIV+, total body Z-scores were lower in those with higher CD4% and in those who ever used boosted protease inhibitors or lamivudine. Lumbar spine Z-scores were lower with higher peak viral load and CD4%, more years on HAART, and ever use of indinavir. Conclusion: Rates of low BMD in HIV+ children were greater than expected based on normal population distributions. These differences were partially explained by delays in growth. As most HIV+ children in this study had not entered their pubertal growth spurt, prepubertal factors associated with BMD, magnified or carried forward, may result in sub-optimal peak BMD in adulthood.