Bone Mass in Children and Adolescents Infected with Human Immunodeficiency Virus

Lima, Luiz Rodrigo Augustemak de; Silva, Rosane C.R. da; Giuliano, Isabela de Carlos Back; Sakuno, Telma; Brincas, Sérgio M.; Carvalho, Aroldo P. de

doi:10.1016/j.jped.2013.02.014

Cited by 31 publications

(27 citation statements)

References 25 publications

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“…Post-pubertal HIV-infected males had lower adjusted WB BMC, as well as adjusted WB and LS BMD than controls. Another study conducted in Brazil found no sex differences in patterns of bone measures between HIV-infected boys and girls [61]. Determining whether the sex differences we observed persist throughout the period of skeletal maturation is an important area of future research.…”

Section: Discussionmentioning

confidence: 80%

Efavirenz is associated with higher bone mass in South African children with HIV

Arpadi

Shiau

Strehlau

et al. 2016

Aids

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Background We investigate if switching from a ritonavir-boosted lopinavir (LPV/r)-based to an efavirenz-based antiretroviral therapy (ART) regimen is associated with beneficial bone development. Methods The CHANGES Bone Study follows HIV-infected children who participated in a non-inferiority randomized trial in Johannesburg, South Africa evaluating the safety and efficacy of pre-emptive switching to efavirenz (N=106) compared to remaining on LPV/r (N=113). HIV-uninfected children were also recruited. Whole body (WB) and lumbar spine bone mineral content (BMC) were assessed by dual-energy X-ray absorptiometry (DXA) at a cross-sectional visit. BMC Z-scores adjusted for sex, age, and height were generated. Physical activity (PA) and dietary intake were assessed. CD4 percentage and viral load were measured. We compared bone indices of HIV-infected to HIV-uninfected children and LPV/r to efavirenz by intent-to-treat. Results The 219 HIV-infected (52% male) and 219 HIV-uninfected (55% male) children were 6.4 and 7.0 years of age, respectively. Mean ART duration for HIV-infected children was 5.7 years. WB BMC Z-score was 0.17 lower for HIV-infected children compared to HIV-uninfected children after adjustment for PA, dietary vitamin D and calcium (p=0.03). WB BMC Z-score was 0.55 higher for HIV-infected children switched to efavirenz compared to those remaining on LPV/r after adjustment for PA, dietary vitamin D and calcium, CD4 percentage and viral load (p<0.0001). Conclusion South African HIV-infected children receiving ART have lower bone mass compared to HIV-uninfected controls. Accrued bone mass is positively associated with switching to efavirenz-based ART compared to remaining on LPV/r, providing additional rationale for limiting LPV/r exposure once viral suppression has been achieved.

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Section: Discussionmentioning

confidence: 80%

Efavirenz is associated with higher bone mass in South African children with HIV

Arpadi

Shiau

Strehlau

et al. 2016

Aids

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“…14–20 In South Africa, school-aged children spend 20 minutes per day in moderate or vigorous physical activity. 9–13 However, no studies describe physical activity or sedentary behaviors among children with HIV who may have greater lifetime risk for cardiovascular disease due to cumulative lifetime exposure to HIV and ART.…”

mentioning

confidence: 99%

Decreased Vigorous Physical Activity in School-Aged Children with Human Immunodeficiency Virus in Johannesburg, South Africa

Wong

Shiau

Yin

et al. 2016

The Journal of Pediatrics

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Objective To describe physical activity in South African children with and without HIV. Study design Study measurements were obtained in 218 children with perinatal HIV and 180 children without HIV aged 5–10 years in a study conducted in Johannesburg, South Africa. Weight-for-age (WAZ) and height-for-age (HAZ) Z-scores, and frequency and duration of moderate and vigorous physical activity, and sedentary behavior, were obtained. Measures were compared between children with and without HIV. Results WAZ and HAZ were significantly lower for children with HIV compared with those without HIV. Among children who attended school, less children with HIV participated in physical education (41 vs. 64%, p=0.0003) and organized after-school sports (38 vs. 64%, p<0.001) than children without HIV. The proportion of children in both groups meeting World Health Organization recommendations for physical activity was similar (84% overall). However, girls with HIV spent less time in vigorous physical activity than girls without HIV (420 vs. 780 minutes/week, p=0.001). This difference remained significant even when girls with medical conditions with potential to limit physical activity were excluded, and after adjusting for age. Time spent in sedentary behaviors did not differ significantly between the groups. Conclusion Although children with HIV with well-controlled disease after initiating antiretroviral therapy early in life achieve high levels of physical activity, vigorous physical activity is lower in girls with HIV than in healthy controls. This may reflect lower participation in school-based physical education and organized after-school physical activity.

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“…Incorporating the supplements into isoenergetic biscuits could also address the issue of blinding (if the non-LCP biscuits were dyed green) and might improve adherence and acceptability (28) . The Ca content of both supplements might be expected to ameliorate low bone mass, an effect of HIV infection that has been reported for children and adolescents (29) , although longer follow-up would probably be required to detect any such effects. Trials that aim to test novel dietary interventions would benefit from information obtained from qualitative research into local tastes and preferences (30) .…”

Section: Discussionmentioning

confidence: 93%

Leaf concentrate compared with skimmed milk as nutritional supplementation for HIV-infected children: a randomized controlled trial in Burundi

Collin

Leclercq²,

Twungubumwe

et al. 2015

Public Health Nutr.

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Objective: The effectiveness of leaf concentrate powder (LCP) as a nutritional supplement was established in trials conducted among adolescent girls and pregnant women in India. Here we evaluate LCP, compared with skimmed milk powder (SMP), as a supplement for antiretroviral-naïve children living with HIV in a sub-Saharan African country. Design: Randomized controlled, two-arm, 6-month trial comparing effects of isoproteic (5 g) LCP (10 g daily) and SMP (15 g daily) on HIV-1 viral load, CD4+ cell count/percentage, weight/height-for-age, general blood parameters, diarrhoea, respiratory and HIV-related opportunistic infections. . Children in the LCP group reported higher levels of appetite and overall health at 6 months. There were no differences in clinical events or any other outcome measures. LCP was less palatable than SMP to the children in this population, but there were few negative perceptions of appearance, texture and taste.Conclusions: LCP appears to be equivalent to SMP as a nutritional supplement in this population, despite slightly lower palatability. In relation to viral load and CD4 + count, equivalence may indicate no effect in either group. Effectiveness relative to no supplementation remains to be determined.

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Bone Mass in Children and Adolescents Infected with Human Immunodeficiency Virus

Abstract: In the present sample children and adolescents living with HIV have low bone mass for age, and the use of protease inhibitors appears to be related to such decreases.

Cited by 31 publications

References 25 publications

Efavirenz is associated with higher bone mass in South African children with HIV

Efavirenz is associated with higher bone mass in South African children with HIV

Decreased Vigorous Physical Activity in School-Aged Children with Human Immunodeficiency Virus in Johannesburg, South Africa

Leaf concentrate compared with skimmed milk as nutritional supplementation for HIV-infected children: a randomized controlled trial in Burundi

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