title: Bone mineral density in children and adolescents with perinatal HIV infection.
abstract: 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+.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA. dimeglio@iupui.edu
authors.forename: Linda A
authors.initials: LA
authors.lastname: DiMeglio
authors.forename: JiaJia
authors.initials: J
authors.lastname: Wang
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Tracie L
authors.initials: TL
authors.lastname: Miller
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Geffner
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
authors.forename: William
authors.initials: W
authors.lastname: Borkowsky
authors.forename: Janet S
authors.initials: JS
authors.lastname: Chen
authors.forename: Laurie
authors.initials: L
authors.lastname: Dooley
authors.forename: Kunjal
authors.initials: K
authors.lastname: Patel
authors.forename: Russell B
authors.initials: RB
authors.lastname: van Dyke
authors.forename: Roger A
authors.initials: RA
authors.lastname: Fielding
authors.forename: Yared
authors.initials: Y
authors.lastname: Gurmu
authors.forename: Denise L
authors.initials: DL
authors.lastname: Jacobson
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology*; D018791:CD4 Lymphocyte Count; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006128:Growth / Q000502:physiology; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents