Reduced bone mineral mass by dual X-ray absorptiometry (DXA) is reported in children living with HIV (CLWH), but only a few studies of the bone microarchitecture have been conducted.

A new study published in the Journal of Acquired Immune Deficiency Syndromes compared bone architecture and strength in black South African CLWH and uninfected control children by peripheral quantitative computed tomography (pQCT).

Here, 172 CLWH on antiretroviral therapy (ART) and 98 controls in the CHANGES Bone Study in Johannesburg, received pQCT scans of the radius and tibia. Measurements included trabecular and cortical volumetric BMD (vBMD) and bone strength, estimated by the polar strength strain index (SSI) – a validated measure of fracture risk.

The results showed that the average age ofCLWH (51% males) and controls (63% males) was 10.4 years. Mean ART duration for CLWH was 9.5 years – 70.9% were on an efavirenz-based; 28.5% on a lopinavir/ritonavir-based; and one child wasgiven an atazanavir/ritonavir-based regimen. It was found that male CLWH had lower trabecular vBMD at the radius, than controls—after adjustment for age, radial length, and Tanner stage. Bone strength by polar SSI was lower in CLWH than in controls. Additionally, CLWH on an LPV/r-based regimen had lower trabecular vBMD and cortical vBMD than those on an efavirenz-based regimen. However, there was no difference with respect to bone strength by polar SSI, between treatment groups.

It was inferred that CLWH initiated on ART early in life with well-controlled HIV, have deficits in bone architecture and reductions in bone strength as detected by pQCT.

Source: Journal of Acquired Immune Deficiency Syndromes.2020 Mar 2. doi: 10.1097/QAI.0000000000002309.