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Emerging Long Term Complications of HIV and its Therapies in Children, Adolescents and Women
Monday, 4ľ6 pm
Background: The development of precise non-invasive methods for measuring bone mineral content has significantly improved our ability to study the changes in bone mass occurring during growth. The most commonly employed method for the assessment of bone mineral content is dual-energy x-ray absorptiometry (DXA). Bone mineral content values are frequently divided by the projected area of the bone analyzed, and the resulting measurements are conventionally referred to as bone mineral density. Bone metabolism rate can be assessed accurately by measuring in serum or urine specific biochemical markers. These markers are based on the measurements of either an enzymatic activity characteristic of the bone-forming or -resorbing cells, or bone matrix components released into the circulation during bone apposition or resorption. The concentration of bone metabolism markers changes markedly during childhood and adolescence. Maximum levels are observed in infancy and during the pubertal period. Reduced DXA bone mass measurements have been found in HIV-infected children. Low and bone mineral density values have been found in the axial and the whole skeleton. The vast majority of the patients were receiving antiretroviral treatment at the moment of the study, making difficult to define the role of treatment on the development of low bone mass. Nevertheless, recent evidence indicates that HIV-infected children na´ve to antiretroviral treatment have normal bone mass measurements. Moreover, longitudinal studies indicate that annual bone mineral density increments of the whole skeleton are significantly lower in HIV-infected patients than in healthy children and adolescents. Bone mass deficit is coupled with marked alterations of bone metabolism. Bone formation indexes have been found to be very elevated in HAART-treated young patients. Moreover, bone resorption rate has been found to be higher than normal in these patients. Conclusions: The available data indicate that bone metabolism derangement is present in children on HAART, and that such alterations might be the cause of the detected low bone mineral density values. This observation is of great concern because of the dramatic improvement in life expectancy of HIV-infected children: impairments in obtaining an optimal bone mass should be identified during childhood to avoid future complications.