10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 6-8 November 2008, London, UK

TOTAL BODY AND SPINE BONE MINERAL DENSITY ACROSS TANNER STAGES IN VERTICALLY HIV-INFECTED COMPARED WITH UNINFECTED CHILDREN AND YOUTH: PRELIMINARY RESULTS OF PACTG1045

Antiviral Therapy 2008; 13(Suppl. 4):A15 (abstract no. O-20)

DL Jacobson¹, JC Lindsey¹, GM Aldrovandi², CM Gordon³, B Heckman⁴, A Zadzilka⁴, E Sheeran⁵, J Moye⁶, P Borum⁷, D Hardin⁸ and K Mulligan^9
1Harvard School of Public Health, Boston, MA, USA; ²Children’s Hospital of Los Angeles, Los Angeles, CA, USA; ³Children’s Hospital Boston, Boston, MA, USA; ⁴Frontier Science and Technology Research Foundation, Amherst, NY, USA; ⁵Social and Scientific Systems, Inc., Silver Spring, MD, USA; ⁶National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA; ⁷University of Florida, Gainesville, FL, USA; ⁸The Ohio State University, Columbus, OH, USA; ⁹University of California San Francisco, San Francisco, CA, USA

AIM: To characterize differences in total body bone mineral content (BMC) and total body and spinal bone mineral density (BMD) between perinatally HIV-infected (HIV-pos) and uninfected (HIV-neg) children and youths across stages of pubertal development.

METHODS: HIV-pos youths, aged 7–24 years, were randomly selected for cross-sectional study from six strata based on Tanner stage (1, 2–3 and 4–5) and protease inhibitor (PI) use (PI≥12 months versus non-PI-containing ART) across 37 PACTG sites. From these clinics, HIV-neg youths of similar age were selected from the same three Tanner strata to reflect overall gender and race distribution of the first 100 HIV-pos youths (group-matching). BMC and BMD were measured by DXA and results were standardized in a central laboratory. Tanner stage was recategorized (1–2, 3–4 and 5) because growth velocity is greatest at Tanner 3 and 4. Using linear regression models for each outcome, differences between HIV-pos and HIV-neg were evaluated across Tanner stage, adjusted for DXA type, race/ethnicity, gender, height, age and potential risk factors for low BMD (CD4% and viral load [current and worst], Centers of Disease Control and Prevention class, vitamin D and calcium intake, exercise and TV hours). Models were tested for two- and three-way interactions of HIV status, Tanner stage and height. Separate models were fit for males and females. We calculated the predicted mean BMD/BMC at the median height of HIV-pos and at the median height of HIV-neg within each Tanner group.

RESULTS: Adequate DXA measurements were obtained in 236 HIV-pos (median age 12.6 years) and 143 HIV-neg (median age 11.9 years) youths. The two groups were comparable for gender (52.5% versus 58.0% male) and race/ethnicity (White/ other 13.1% versus 14.0%, Black 54.7% versus 54.5% and Hispanic 32.2% versus 31.5%). Among females, there were no significant differences between HIV-neg and HIV-pos for total body BMC (P=0.524), total BMD (P=0.784) or spinal BMD (P=0.967) at any Tanner stage. In contrast, among males, there were statistically significant three-way interactions between HIV status, Tanner stage and height on all three outcomes (total body BMD P=0.028; spinal BMD P=0.039; total BMC P=0.045). At Tanner stage 1–2, predicted BMD and BMC were similar between HIV-pos and HIV-neg males, but HIV-pos had lower BMD/BMC than HIV-neg males at Tanner stages 3–4 and 5. Non-Hispanic African-Americans had significantly higher BMC (males and females), total BMD (males and females) and spine (females only) followed by Hispanics and then Whites.

CONCLUSION: In this random sample of youth, HIV-pos males showed evidence of delayed bone density compared with HIV-neg males. The difference between the groups was most pronounced at the final stage of pubertal development. In contrast, there was no effect of HIV status on BMC or BMD among females. These data suggest that perinatally infected males might be at increased risk for bone disease during adulthood.

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2008-11-06
O-20

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