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Session 104 Poster Abstracts
Systemic and Organ Complications of HIV-1 and Antiretroviral Therapies
Monday, 1:30 - 3:30 pm
Poster Hall


753
Endocrinologic Abnormalities and Impaired Growth in HIV-infected Children
C Chantry*1, M Frederick2, W Meyer3, E Handelsman4, D Turpin5, M Paul6, S Adeniyi-Jones7, J Moye8, and the Women and Infants Transmission Study (WITS)
1Univ. of California, Davis, USA; 2Clin. Trials & Surveys Corp., Baltimore, MD, USA; 3Quest Diagnostics Inc., Baltimore, MD, USA; 4State Univ. of New York Hlth. Sci. Ctr., Brooklyn, USA; 5Univ. of Illinois at Chicago, USA; 6Baylor Coll. of Med., Houston TX, USA; 7NIAID, NIH, DHHS, Bethesda, MD, USA; and 8NICHD, NIH, DHHS, Bethesda, MD, USA

Background:  Endocrine derangements are suspected in association with growth impairment observed in pediatric HIV disease but available data are limited and inconclusive. 

Methods:  We performed a nested case-control study in 21 HIV-infected and 46 age- and sex-matched uninfected pediatric subjects enrolled in the WITS prospective cohort study of HIV-infected pregnant women and the children born to them. Blood was collected and routine anthropometry performed by trained examiners every 6 months. Stored plasma from 3 to 4 time points each between ages 2.5 to 8.0 years was tested for insulin-like growth factor binding protein-3 (IGF-BP3), cortisol, dehydroepiandrosterone (DHEA), growth hormone (GH), T3 uptake, and total and free T4. Each analyte was tested by a single licensed clinical laboratory (Quest Diagnostics’ Nichols Institute; San Juan Capistrano, CA, or Quest Diagnostics; Baltimore, MD) blind to subject infection status. Group means were compared by longitudinal mixed models incorporating infection status and time. Generalized estimating equation modeling was used to examine effects of endocrine measures as time-dependent variables on growth outcomes. Z scores for weight, height, and body mass index were computed using the 2000 CDC/NCHS growth reference.

Results:  The group’s estimated means (±SE) at 6 years are shown below:

 

Analyte

Infected

Uninfected

p

IGF-BP3, mg/L

2.17±0.10

2.53±0.07

0.001

Cortisol, μg/dL

9.98±1.17

8.97±0.81

0.657

DHEA, ng/dL

43.7±8.80

41.4±5.89

0.303

GH, ng/mL

2.19±1.15

2.27±0.68

0.972

T3 uptake, %

28.4±0.82

29.6±0.56

0.002

Total T4, μg/dL

8.46±0.41

8.13±0.28

0.314

Free T4 Index

2.36±0.10

2.40±0.07

0.373

 

HIV infection was negatively associated with Z scores for weight (p = 0.011) and height (p <0.001). Significant positive associations were observed between IGF-BP3 and Z scores for weight (p = 0.024) and body mass index (p = 0.037), and between DHEA and height (p = 0.012). 

Conclusions:  Distributions of all endocrine measures but total T4 were shifted downward in infected compared with uninfected children. IGF-BP3 and T3 uptake were significantly lower across all ages. Somatomedin, adrenal, and thyroid derangements appear to be present and associated with reduced somatic growth observed in HIV disease. 

Keywords: growth; endocrine; children