title: Bone mineral density and vitamin D concentration: the challenges in taking care of children and adolescents infected with HIV.
abstract: BACKGROUND
  The increase in life expectancy for patients living with human immunodeficiency virus (HIV) infection has resulted in health complications related to a chronic disease.
  
  
  OBJECTIVE
  To evaluate the prevalence of bone mineral density (BMD) alterations and vitamin D concentrations in HIV-infected children and adolescents and to verify the variations in those parameters during a 12-month interval.
  
  
  METHODS
  A prospective cohort study with a dual period of evaluation was conducted in 57 patients perinatally HIV-infected and one patient with sexual abuse in early infancy. Demographic, anthropometric, pubertal stage, viral load, T CD4+ cell count and antiretroviral therapy were evaluated. Biochemical tests and total body (TB) and lumbar spine (L1-L4) bone density evaluations by dual X-ray absorptiometry (DXA) were performed. Calcium or vitamin D supplements were prescribed if reduction in BMD or deficiency for vitamin D was detected.
  
  
  RESULTS
  58 patients (ages 5.4-18.3 years; 60.3% girls) were included (T0); 55 patients were reevaluated after 12 (±3) months (T1). Low bone mass for chronological age was found in 6/58 (10.4%) and 6/55(10.9%) patients at T0 and at T1, respectively. There was no statistical relationship between z-scores for BMD (BMD z-score) and the variables sex, fracture history, family history of osteoporosis, physical activity and pubertal stage. There was a relation between BMD z-score alterations for TB and HIV viral load at T1 (p=0.016). There was no association between duration or classes of antiretroviral therapy and bone density. The mean value of vitamin D in T0 was 23.43ng/mL±2.015 and in T1 22.1ng/mL±0.707 and considered insufficient levels for this population.
  
  
  CONCLUSIONS
  Patients infected with HIV are at risk for BMD alterations and lower vitamin D serum concentrations; both of these variables should be evaluated at routine examinations in order to improve both prevention and therapeutic planning.
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil.
authors.forename: Fabiana Bononi
authors.initials: FB
authors.lastname: Carmo
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Setor de Reumatologia da Pediátrica, São Paulo, SP, Brazil.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil.
authors.forename: Regina Célia de Menezes
authors.initials: RCM
authors.lastname: Succi
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil.
authors.forename: Suenia Vasconcelos
authors.initials: SV
authors.lastname: Beltrão
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil.
authors.forename: Aida de Fátima Tomé Barbosa
authors.initials: AFTB
authors.lastname: Gouvea
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil.
authors.forename: Erica Regina Cruz
authors.initials: ERC
authors.lastname: Paulino
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Centro de Atendimento da Disciplina de Infectologia Pediátrica (CEADIPe), São Paulo, SP, Brazil. Electronic address: daisymmachado@gmail.com.
authors.forename: Daisy Maria
authors.initials: DM
authors.lastname: Machado
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density / Q000502:physiology*; D018791:CD4 Lymphocyte Count; D002118:Calcium / Q000008:administration & dosage*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D019562:Viral Load; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood*
chemical_list: D014807:Vitamin D; D002118:Calcium
keywords: Antiretroviral; Bone; Diagnosis; HIV; Infant; Metabolism