Bone Accrual Trajectories in Children and Adolescents With Perinatal HIV Infection

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.