AEGiS-14IAC: Growth hormone deficiency in children with perinatally acquired human immunodeficiency virus infection.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Growth hormone deficiency in children with perinatally acquired human immunodeficiency virus infection.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10220)

Ezeanolue EE, Hardy SL, Nunlee-Bland G, Frederick WR
Department of Pediatrics, Howard University Hospital, Washington, D.C., United States

BACKGROUND: Reports of growth hormone (GH) deficiency in HIV+ children are rare. HIV+ children with growth failure were found to have opportunistic infections (OI) and low CD4+ cell counts but normal GH and insulin like growth factor 1 (ILGF-1) serum concentrations. We herein report three African-American male children with GH deficiency and growth failure without OI from among our cohort of HIV+ and in utero HIV exposed negative children.

METHODS: At birth antibody (Ab) to HIV was detected by ELISA, confirmed by Western blot. Radioimmunoassays were used to measure the serum levels of GH, ILGF-1 and adenocorticotropin hormone (ACTH). Stimulation tests with arginine and L-Dopa were performed using standard procedures.

RESULTS: At the time of evaluation the children's ages ranged 3.5-7 years. Their mothers were IVDUs, HIV+ and took AZT during their pregnancies. At birth the children were HIV+ by ELISA and received 6 weeks of AZT. At the time of evaluation one was HIV-, two were HIV+ and on HAART. All three children had delayed bone age, had heights and weights below 2 standard deviation scores (SDS) for age and no other significant physical findings. SDS and endocrine testing documented growth failure in all three. They were found to have abnormal GH and ILGF-1 serum levels and abnormal GH stimulation tests. In addition, the HIV- child had ACTH deficiency and the two HIV+ children had abnormal insulin growth factor binding protein 3. Two children (1 HIV-, 1 HIV+) had hypoplasia of the pituitary gland on magnetic resonance imaging of the head. The children are now on GH replacement therapy with good response in growth velocity.

CONCLUSIONS: Isolated GH deficiency in HIV+ children may be more common than currently appreciated. GH deficiency should be investigated in all HIV+ and in utero HIV exposed negative children with growth failure. Further studies are needed to determine the cause of this deficiency and the role of HIV infection and AZT therapy.

Keywords: AEGIS, HIV Infections, Hypopituitarism, Growth Hormone, Insulin-Like Growth Factor I, Body Height, Growth Disorders, Zidovudine, CD4 Lymphocyte Count, HIV Seropositivity, Dwarfism, Pituitary, Growth, Pituitary Gland, Insulin, Hormones, Radioimmunoassay, Enzyme-Linked Immunosorbent Assay, Child, Human, Male

020707
B10220