Objective
To evaluate the association between HIV infection and sexual maturation, and mediation of this association by HIV effects on growth.
Design
Pooled data were analyzed from two longitudinal cohort studies, the IMPAACT P219/219C Study (1993–2007) and the PHACS Adolescent Master Protocol (2007–2015), including perinatally HIV-infected (PHIV) and HIV-exposed uninfected (PHEU) youth.
Methods
We evaluated age at sexual maturity among 2539 PHIV and PHEU adolescents based on annual physician-assessed pubertal staging measures. Interval-censored regression models were used to evaluate associations of HIV infection with age at maturity. Mediation analyses accounting for height and body mass index (BMI) Z-scores at specific ages were used to estimate direct and indirect effects of HIV infection on age at sexual maturity.
Results
Mean ages at sexual maturity for PHIV girls (n=1032) were 15.5 years for both female breast and pubic hair and 15.9 and 15.8 years for PHIV boys (n=1054) for genitalia and pubic hair, respectively. PHIV youth matured approximately 6 months later on average than PHEU (n=221 girls, 232 boys), and this difference persisted after adjustment for race/ethnicity and birth cohort. BMI and height Z-scores mediated the association between HIV infection and later maturation in girls, accounting for up to 74% of the total HIV effect. Only height Z-scores mediated the effect of HIV on male age at maturity, accounting for up to 98% of the HIV effect.
Conclusion
PHIV youth attain sexual maturity later on average than PHEU youth. Much of this difference may be attributable to deficient growth, suggesting directions for future interventions.