Background: Adults infected with HIV are at increased risk for osteopenia. Adults receiving protease inhibitor-containing Highly Active Antiretroviral Therapy (HAART) are at increased risk for bone demineralization when compared to those not receiving protease inhibitors. Retrospective pediatric studies suggest that there is an increase in the incidence rate of avascular necrosis of the femoral head in HIV-infected children. However, prospective data are limited on bone demineralization in children.

Methods: This was a prospective cross-sectional study evaluating the prevalence and relationship to protease inhibitor-containing HAART of osteopenia and osteoporosis in HIV-infected children. Lumbar spine bone mineral density (BMD) was assessed using Dual-Energy X-ray Absorptiometry (DEXA). For this study, osteopenia was defined as a Z-score between -1.0 and -2.5; osteoporosis was defined as a Z-score below -2.5.

HIV-infected children 6- to 17-years-old were eligible for the study. The child or caregiver was asked to complete a 3-day food record. Serum calcium, alkaline phosphatase, vitamin D 25, and vitamin D 1,25 values were determined. Each participant underwent whole-body and lumbar spine DEXA. A two-tailed T-test for independent samples was used to evaluate the relationship between use of protease inhibitor-containing HAART and the prevalence of osteopenia, as well as whether the number of months a child had received a protease inhibitor contributed to the severity of osteopenia.

Results: Of the 26 children completing the study, 18 (69%) were taking protease inhibitor-containing HAART. The mean age was 11 years and 13 (50%) were female. Most children met or exceeded the RDA/age for calcium intake based on a nutritional assessment of the food records using Nutrition Data System for Research version 4.04_32. No child was hypocalcemic or vitamin D deficient.

Seventeen (17, 73%) children had osteopenia and 6 (23%) osteoporosis. There was no difference in mean BMD Z-score between children taking a protease inhibitor-containing regimen and those not taking a protease inhibitor-containing regimen (-1.62 vs -1.69, p = 0.894). The mean duration of protease inhibitor-containing HAART was 42 months. The longer a patient received protease inhibitor therapy, the greater their risk for osteopenia (p < 0.001).

Conclusions: Osteopenia is prevalent among HIV-infected children. There appears to be a relationship between duration of protease inhibitor-containing HAART and prevalence of osteopenia.