Prevalence and risk factors of low bone mineral density among perinatally HIV-infected Thai adolescents receiving antiretroviral therapy.
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 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 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 [interquartile range (IQR)] current CD4 T-cell count was 646 (506-796) cells per cubic millimeter and 90% had plasma HIV-1 RNA <50 copies per milliliter. The mean BMD among HIV-infected adolescents and controls were 0.855 and 0.980 g/cm (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-hydroxyvitamin D 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: 6.2; 95% confidence interval: 2.2 to 17.7) and history of World Health Organization clinical stage 4 before antiretroviral therapy (adjusted odds ratio: 3.7; 95% confidence interval: 1.3 to 10.7) were significantly associated with osteopenia.


CONCLUSIONS
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.
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Thanyawee
T
Puthanakit
Rachanee
R
Saksawad
Torsak
T
Bunupuradah
Orasi
O
Wittawatmongkol
Thongsuai
T
Chuanjaroen
Sasiwimol
S
Ubolyam
Tawatchai
T
Chaiwatanarat
Pairunyar
P
Nakavachara
Alan
A
Maleesatharn
Kulkanya
K
Chokephaibulkit
D015502:Absorptiometry, Photon; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D014807:Vitamin D; C104450:25-hydroxyvitamin D