Bone health and vitamin D status among perinatally HIV-infected Asian children and adolescents with virological suppression

bone mineral density;HIV-infected youth;hypovitaminosis D;Epidemiology

Sudjaritruk, TavitiyaRuff, Andrea J. ;

Johns Hopkins University

关键词: bone mineral density;    HIV-infected youth;    hypovitaminosis D;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/40722/SUDJARITRUK-DISSERTATION-2016.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: Pathogenesis of reduced bone mass and its relationships with hypovitaminosis D in HIV-infected populations are largely unknown. The goals of this dissertation were to determine the prevalence of low bone mass and its pathogenesis, along with the prevalence of hypovitaminosis D and its effects on bone turnover and bone density among HIV-infected Asian adolescents. Methods: A multicenter, cross-sectional study was conducted at four pediatric HIV centers in Thailand and Indonesia. Perinatally HIV-infected adolescents aged 10-18 years receiving antiretroviral therapy with virologic suppression (HIV RNA <400 copies/ml) were enrolled. Study assessments included lumbar spine dual-energy x-ray absorptiometry, 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (iPTH), bone turnover markers [C-terminal cross-linked telopeptide of type I collagen (CTX) and procollagen type I amino-terminal propeptide (PINP)]. Bone mineral density (BMD) and bone mineral apparent density (BMAD) Z-scores were calculated based on Thai normative reference. Z-scores <=-2 was defined as low bone mass. The 25-OHD <20 ng/ml and iPTH >65 pg/ml were defined as hypovitaminosis D and hyperparathyroidism, respectively.Results: Of 396 participants, 57% were female and median age (IQR) was 15.0 (13.3-16.9) years. The prevalence of lumbar spine BMD and BMAD Z-scores <=-2 were 16.4% and 8.3%, respectively. Z-scores were lower with older age, female sex, body mass index <5th percentile, protease inhibitor exposure and CD4+ <15% before ART initiation. Increased bone turnover markers were inversely associated with BMD/BMAD Z-scores. Among 394 adolescents who had 25-OHD results, the prevalence of hypovitaminosis D, hyperparathyroidism, and both conditions were 21% (95%CI: 17-25%), 17% (95%CI: 13-20%) and 5% (95%CI: 3-7%), respectively. Adolescents with hypovitaminosis D and secondary hyperparathyroidism had the highest median bone resorption (CTX: 1610 vs. 1270 ng/l; P=0.04) and bone formation (PINP: 572 vs. 330 μg/l; P=0.02) markers, and the greatest proportion of low BMD (42 vs. 15%; P=0.01) compared to the rest of the cohort.Conclusion: Low bone mass was not uncommon in our adolescents. Bone turnover dysregulation was associated with reduced bone mass. Hypovitaminosis D complicated with secondary hyperparathyroidism was associated with increased bone turnover and bone demineralization. Monitoring of bone mass and vitamin D status may be important for this population.