Antiretroviral therapy and bone mineral measurements in HIV-infected youths

Zuccotti, Gian Vincenzo; Viganò, Alessandra; Gabiano, Clara; Giacomet, Vania; Mignone, F; Stucchi, Sara; Manfredini, Valeria; Marinacci, Francesca; Mora, Stefano

doi:10.1016/j.bone.2010.02.029

Cited by 46 publications

(38 citation statements)

References 26 publications

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“…Além disso, os pacientes que recebiam IP na presente amostra também utilizam d4T e TDF (3/26 e 5/26, respectivamente), indicados como moduladores de reduções na massa óssea. 8,9 Esses antirretrovirais estavam presentes somente na TARV com inclusão de IP; portanto, pode-se supor que as reduções encontradas no grupo que utiliza IP na TARV podem ter sido influenciadas pelos três antirretrovirais de forma associada (LPV/r, d4T e TDF).…”

Section: Resultsunclassified

“…[2][3][4][5][6][7] Apesar das controvérsias, os fatores que contribuem para estas diminuições são o déficit na ingestão de cálcio, a TARV com inclusão de inibidores de protease (IP), os antirretrovirais específicos (estavudina-d4T, tenovovir-TDF e ritonavir-RTV), os estágios avançados da infecção e a lipodistrofia. 3,5,8,9 Embora seja conhecido o potencial da atividade física regular na manutenção da saúde óssea, poucos estudos consideraram esta variável na relação com a DMO/CMO. 3,6,7 O pico de acréscimo mineral ósseo ocorre preponderantemente durante a puberdade; 10 assim, a preocupação com reduções da massa óssea em crianças e adolescentes vivendo com HIV amplia-se, pois estes poderiam desenvolver complicações precoces.…”

Section: Introductionunclassified

See 1 more Smart Citation

Bone mass in children and adolescents infected with human immunodeficiency virus

Lima¹,

Silva

Giuliano

et al. 2013

Jornal de Pediatria (Versão em Português)

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Objective: To describe bone mineral density (BMD) and bone mineral content (BMC) in children and adolescents infected with the human immunodeficiency virus (HIV), and to compare them with data from the National Health and Nutrition Examination Survey IV (NHANES IV). Method: The study included 48 children and adolescents (7 to 17 years old) infected with HIV through vertical transmission. BMC and BMD were measured by dual energy absorptiometry X-ray, by calculating z-scores based on data from NHANES IV. The information on clinical and laboratory parameters of infection by HIV was obtained from medical records. Physical activity, calcium intake, and skeletal maturation were also assessed. Descriptive and inferential statistical procedures were used, with levels of significance set at 5%. Results: Seropositive patients presented lower values compared to data from NHANES IV in all z-scores of bone mass (mean = −0.52 to −1.22, SD = 0.91 and 0.84, respectively). Based on the subtotal z-BMD, there was a prevalence of 16.7% of children and adolescents with low bone mass for age. Individuals using protease inhibitors presented a lower total http://dx.

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Section: Resultsunclassified

Section: Introductionunclassified

Bone mass in children and adolescents infected with human immunodeficiency virus

Lima¹,

Silva

Giuliano

et al. 2013

Jornal de Pediatria (Versão em Português)

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“…Infected children on ART have been shown to have lower BMD when compared with ART-naive and HIV-negative children (39). Decreased BMD leads to osteopenia and osteoporosis, with a higher risk of pathologic fractures.…”

Section: Bmdmentioning

confidence: 99%

“…Decreased BMD leads to osteopenia and osteoporosis, with a higher risk of pathologic fractures. In Italy, Zuccotti et al (39) showed decreased bone mineral content in HIV-infected youth (aged 4.8-22 y) who were receiving a PI (full-dose ritonavir)-based regimen compared with healthy HIVnegative youth. In addition, those on a stavudine-based regimen were shown to have decreased BMD.…”

Section: Bmdmentioning

confidence: 99%

Severe malnutrition and metabolic complications of HIV-infected children in the antiretroviral era: clinical care and management in resource-limited settings

Musoke¹,

Fergusson²

2011

The American Journal of Clinical Nutrition

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More than 2 million children globally are living with HIV infection and .90% of these reside in sub-Saharan Africa. Severe acute malnutrition (SAM) remains a major problem for HIV-infected children who live in resource-limited settings (RLS), and SAM is an important risk factor for mortality. SAM in HIV-infected children is associated with complications including electrolyte disorders, micronutrient deficiencies, and severe infections, which contribute to the high mortality. Access to antiretroviral therapy (ART) has significantly improved the survival of HIV-infected children, although the response to ART of children with SAM remains undocumented in the literature. Immune and virologic responses to ART in RLS are similar to those of infected children in resource-rich settings, but delays in initiation of therapy have led to a high early mortality. Antiretroviral drug toxicities have been described in children who receive therapy and may affect their quality of life and long-term survival. Metabolic complications of ART include lipodystrophy, dyslipidemia, lactic acidosis, insulin resistance, and osteopenia. These complications have been well described in adults and children from developed countries, but data from RLS are limited, and these complications may be compounded by SAM. In this article we review the epidemiology, clinical presentation, and complications of SAM in HIV-infected children and the metabolic complications of HIV-infected children in the era of ART, and discuss future research priorities for RLS.Am J Clin Nutr 2011;94(suppl):1716S-20S.

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“…Only children receiving a protease inhibitor-based regimen had significantly lower bone mass, although there was marked variability in age, sex and sexual maturity between groups. These investigators also measured markers of bone turnover and found the bone formation rate did not differ by exposure to ART or specific ART regimens, and there was no relationship between bone mass and bone turnover markers [27]. In a small cohort of 21 perinatally infected children, there was no evidence for bone loss over 5 years' treatment with a tenofovir-containing ART regimen [28].…”

Section: Children and Adolescentsmentioning

confidence: 99%