Background:  Osteoporosis is a well-recognized complication of HIV infection. However it is not yet clear whether it depends on therapy, HIV infection itself, or both. Decreased bone mineral content (BMC) has been described in antiretroviral treated children. The reports on adult patients, naive to antiretroviral treatment, are few and controversial while paediatric data are lacking.  

Methods:  BMC  at the lumbar spine (L2-L4) and in the total body was assessed by dual-energy X-ray absorptiometry in 59 HIV-infected children:  16  naïve to antiretroviral treatment (aged 9.3±0.9 years) and 43 HAART-treated (aged 11.4±0.5 years). Among the HAART treated children, 41 were receiving a PI-based HAART regimen and 2 MEGA HAART. The mean exposure to HAART was 40.3 (1.07) months. Results were compared with those obtained in 159 healthy children of comparable age (10.3±0.3 years). Differences between HIV infected and healthy controls were assessed by multivariate analyses, after controlling for confounding variables.

Results:  The 3 groups of subjects were similar for age, weight, height, and sex distribution. BMI of untreated patients was significantly higher than that of the other groups of subjects (p <0.001). Correlation analysis showed that age and anthropometric variables were highly correlated, while BMI showed moderated correlations with age and anthropometric variables. Age, BMI, and bone area, as well as sex, were selected as the confounding variables in the regression models. The sBMC values in children naive to treatment were similar to those of healthy controls, in a model that explained 95% of the variability (R² = 0.95). Similarly, the total body BMC values of  children naive to treatment was similar to  that of healthy controls (p = 0.24), in a model that explained 98% of the variability (R² = 0.98). To the contrary, sBMC values of HAART-treated patients were lower than those of healthy controls (p = 0.007); the model used showed a R² value of 0.96. A similar and significant (p <0.0001) difference was found between HAART-treated children and healthy controls for total body BMC, the model showed a R² value of 0.97. In addition, we did not find a relationship between the duration of HIV infection and BMC, measured at the lumbar spine and total body.

Conclusions:  Our data suggest a role of antiretroviral treatment in the genesis of low bone mass observed in HIV-infected youth. The potential for long term complication of decreased BMC is particularly concerning given that peak bone mass is reached by young adulthood.

Keywords: Bone Mass; HAART; children