Bone health in HIV-infected children and adolescents

Abstract

Purpose of review Chronic HIV infection and exposure to antiretroviral therapy compromises bone health in children and adolescents, potentially impacting their long-term quality of life. Thus, the purpose of this paper is to review the most recent literature on this topic in HIV-infected children and adolescents. Recent findings Recent studies continue to demonstrate bone abnormalities in HIV-infected children and adolescents, whether HIV is acquired perinatally or during adolescence. Researchers have employed new modalities, both high tech and those that can be utilized in resource-limited settings, to better assess bone health. New data suggest that this population may also be experiencing an increase incidence of factures, and they may not acquire the same peak bone mass as their HIV-uninfected counterparts. Reassuringly, however, in utero tenofovir exposure does not appear to have a significant impact on bone health in HIV-exposed, uninfected infants. Summary Recent findings underscore the need for further research on bone in HIV-infected children and adolescents. Longitudinal studies are especially needed to evaluate long-term risk of osteoporosis and fractures, since this population is exposed to HIV and antiretroviral therapy for many decades starting early in life and during the most critical time for skeletal growth and bone mass accrual.

Accelerated aging in perinatally HIV-infected children: clinical manifestations and pathogenetic mechanisms

“…Children with HIV infection can develop precocious bone abnormalities with an increased risk of osteoporosis and fractures [36]. The risk of bone disorder is greater in children than in adults, because bone mass increases during childhood, accelerating during adolescence [37,38].…”

“…The cause is multifactorial and not fully clear, but many demographic, genetic, hormonal, nutritional factors, HIV levels and drugs are involved. Long-term ART, especially including tenofovir, disoproxil, and fumarate, is associated with greater bone loss [36,37]. Furthermore, precocious bone abnormalities are probably correlated with HIV-related chronic inflammation: pro-inflammatory cytokines, such as interleukin (IL)-1, IL-6, IL-17, and TNF-α can boost osteoclast and suppress osteoblast activity or cause their apoptosis [39–41].…”

Evaluación de la densidad mineral ósea en niños con infección vertical por VIH

“…Durante la adolescencia, las hormonas sexuales interfieren en la antropometría y composición corporal y aumentan directamente la masa ósea. La infección por VIH/SIDA es una enfermedad crónica en que el retraso en el desarrollo puberal puede ocurrir con frecuencia, por lo que la edad cronológica puede ser mayor que la edad biológica y se hace necesario no sólo comparar por edad a los pacientes sino además, por estadio puberal 36,37 . Por otro lado, la actividad física es un factor ambiental importante que influye positivamente en la acumulación de masa ósea, principalmente durante la pubertad 38 .…”

A Global Research Agenda for Adolescents Living With HIV

“… 28 In addition, HIV has been associated with long-term complications for vertically infected adolescents, which include but are not limited to cognitive impairment 29 ; poor lung function and chronic lung disease 30 – 32 ; delayed pubertal onset and growth failure 33 ; cardiovascular disease and metabolic complications 34 , 35 ; and poor bone health. 36 These findings underscore the need for further research on the long-term impact of HIV and ART during this critical time of development.…”