Abstract
SummaryIn this study, we evaluated the relationships between immune activation, bone turnover, and bone mass in virally suppressed HIV-infected children and HIV-uninfected children in South Africa. We found that decreased bone mass may occur or persist independent of immune activation and altered bone turnover.PurposeHIV-infected children and adolescents have deficits in skeletal growth which include decreases in bone mass and alterations in bone microarchitecture. However, the mechanism by which HIV infection compromises bone accrual in children and adolescents is unclear. The goal of this study was to evaluate the relationships between immune activation, bone turnover, and bone mass in a group of pre-pubertal HIV-infected children randomized to remain on ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy (ART) or switch to efavirenz-based ART in South Africa virally suppressed at the time of this study.MethodsThis cross-sectional analysis included 219 HIV-infected and 180 HIV-uninfected children enrolled in the CHANGES Bone Study conducted in Johannesburg, South Africa. Whole body (WB) bone mineral content (BMC) was assessed by dual x-ray absorptiometry and WB BMC Z-scores adjusted for sex, age, and height were generated. Bone turnover markers, including C-telopeptide of type 1 collagen (CTx) and procollagen type I N-terminal propeptide (P1NP), were analyzed. Markers of immune activation were also measured, including cytokines IL-6 and TNF-alpha, as well as soluble CD14 and high-sensitivity C-reactive protein (CRP).ResultsCompared to uninfected controls, HIV-infected children had lower WB BMC Z-scores, similar IL-6 and TNF-alpha, higher soluble CD14 and high-sensitivity CRP, and lower markers of bone resorption (CTX) and bone formation (P1NP). Bone turnover markers were not different in those remaining on LPV/r or switched to efavirenz.ConclusionsOur findings suggest that in HIV-infected children with viral suppression, decreased bone accrual may occur or persist independent of immune activation and altered bone turnover.
Highlights
HIV-infected children and adolescents have deficits in skeletal growth which include decreases in bone mass accrual and alterations in bone microarchitecture [1, 2]
Among children remaining on ritonavir-boosted lopinavir (LPV/r)based antiretroviral therapy (ART), we observe lower accrued bone mass compared to children switching to efavirenz-based ART
The primary goal of this study was to evaluate the relationships between immune activation, bone turnover, and bone mass in a group of well-suppressed pre-pubertal HIVinfected children in urban South Africa randomized to remain on LPV/r-based ART or switch to efavirenz-based ART [13, 14]
Summary
HIV-infected children and adolescents have deficits in skeletal growth which include decreases in bone mass accrual and alterations in bone microarchitecture [1, 2]. Among children remaining on ritonavir-boosted lopinavir (LPV/r)based ART, we observe lower accrued bone mass compared to children switching to efavirenz-based ART. This disruption of bone accrual during critical periods of skeletal development can compromise adult peak bone mass and increase the risk of later life osteoporosis and fracture [4, 5]. In HIV-infected adults, higher serum levels of pro-resorptive cytokines and T cell activation markers are associated with lower bone mineral density (BMD) [6,7,8,9], suggestive of immune activationmediated increased bone resorption. In the few available studies of bone turnover markers in HIV-infected children, findings are inconsistent [10,11,12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
