Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Acquir Immune Defic Syndr. 2012 Dec 1;61(4):477-83. doi: 10.1097/QAI.0b013e31826ea89b.
Low bone mineral density (BMD) has been reported among 10%-54% of HIV-infected adolescents in developed countries. We studied the prevalence and predictors of low BMD among HIV-infected Thai adolescents receiving antiretroviral therapy.
A cross-sectional study of lumbar spine (L2-L4) BMD as measured by dual-energy X-ray absorptiometry in Thai HIV-infected adolescents aged 12-20 years was performed. The BMD Z score was analyzed using age-matched healthy Thai children as a reference. Serum 25-hydroxyvitamin D was performed. Osteopenia was defined as BMD Z score ≤ -2.
From October 2010 to February 2011, 101 adolescents, 50% male, with a median age of 14.3 (range: 13.0-15.7) years were enrolled. The median [interquartile range (IQR)] current CD4 T-cell count was 646 (506-796) cells per cubic millimeter and 90% had plasma HIV-1 RNA <50 copies per milliliter. The mean BMD among HIV-infected adolescents and controls were 0.855 and 0.980 g/cm (P < 0.001). The median (IQR) L2-L4 spine BMD Z score was -1.0 (-1.9 to -0.1), of which 24% had BMD Z score ≤ -2.0. The median (IQR) of 25-hydroxyvitamin D level was 24.8 (20.0-31.4) ng/mL, of which 25% had vitamin D level < 20 ng/mL. In multivariate analysis, the height for age Z score < -1.5 (adjusted odds ratio: 6.2; 95% confidence interval: 2.2 to 17.7) and history of World Health Organization clinical stage 4 before antiretroviral therapy (adjusted odds ratio: 3.7; 95% confidence interval: 1.3 to 10.7) were significantly associated with osteopenia.
One fourth of HIV-infected Thai adolescents have osteopenia. Children with history of advanced-staging or having low height for age are at risk of osteopenia. Preventive measures to prevent osteopenia should be incorporated in routine care for these adolescents.
在发达国家，10%-54%的 HIV 感染青少年存在骨矿物质密度（BMD）降低的情况。我们研究了接受抗逆转录病毒治疗的泰国 HIV 感染青少年中 BMD 降低的患病率和预测因素。
对 12-20 岁接受抗逆转录病毒治疗的泰国 HIV 感染青少年进行腰椎（L2-L4）BMD 的双能 X 线吸收法测量。使用年龄匹配的健康泰国儿童作为参考，分析 BMD Z 评分。检测血清 25-羟维生素 D。骨密度减少定义为 BMD Z 评分≤-2。
2010 年 10 月至 2011 年 2 月，共纳入 101 名青少年（50%为男性），中位年龄 14.3 岁（范围：13.0-15.7 岁）。当前 CD4 T 细胞计数的中位数[四分位间距（IQR）]为 646（506-796）个细胞/立方毫米，90%的患者血浆 HIV-1 RNA ＜50 拷贝/毫升。HIV 感染青少年和对照组的平均 BMD 分别为 0.855 和 0.980 g/cm（P＜0.001）。L2-L4 脊柱 BMD Z 评分的中位数（IQR）为-1.0（-1.9 至-0.1），其中 24%的患者 BMD Z 评分≤-2.0。25-羟维生素 D 水平的中位数（IQR）为 24.8（20.0-31.4）ng/ml，其中 25%的患者维生素 D 水平＜20ng/ml。多变量分析显示，身高年龄 Z 评分＜-1.5（调整后的优势比：6.2；95%置信区间：2.2 至 17.7）和抗逆转录病毒治疗前的世界卫生组织临床分期 4 期病史（调整后的优势比：3.7；95%置信区间：1.3 至 10.7）与骨质疏松症显著相关。
四分之一的 HIV 感染泰国青少年存在骨质疏松症。有晚期病史或身高矮小的儿童有发生骨质疏松症的风险。应在常规护理中纳入预防骨质疏松症的措施，以保护这些青少年。
