Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 19-114, New York, NY, 10032, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Arch Osteoporos. 2018 Apr 5;13(1):40. doi: 10.1007/s11657-018-0452-6.
In 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.
HIV-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.
This 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).
Compared 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.
Our 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.
HIV 感染的儿童和青少年存在骨骼生长缺陷，包括骨量减少和骨微结构改变。然而，HIV 感染如何损害儿童和青少年的骨量积累尚不清楚。本研究的目的是评估在南非一组接受利托那韦增强洛匹那韦（LPV/r）为基础的抗逆转录病毒治疗（ART）或转换为依非韦伦为基础的 ART 的病毒抑制的青春期前 HIV 感染儿童中，免疫激活、骨转换和骨量之间的关系。
本横断面分析纳入了在南非约翰内斯堡进行的 CHANGES 骨骼研究中的 219 名 HIV 感染儿童和 180 名 HIV 未感染儿童。全身（WB）骨矿物质含量（BMC）通过双能 X 线吸收法评估，并生成了调整性别、年龄和身高的 WB BMC Z 分数。分析了骨转换标志物，包括 1 型胶原 C 端肽（CTX）和前胶原 I N 端原肽（P1NP）。还测量了免疫激活标志物，包括细胞因子 IL-6 和 TNF-α，以及可溶性 CD14 和高敏 C 反应蛋白（CRP）。
与未感染对照组相比，HIV 感染儿童的 WB BMC Z 分数较低，IL-6 和 TNF-α相似，可溶性 CD14 和高敏 CRP 较高，骨吸收标志物（CTX）和骨形成标志物（P1NP）较低。在继续接受 LPV/r 或转换为依非韦伦的患者中，骨转换标志物无差异。
我们的发现表明，在病毒抑制的 HIV 感染儿童中，骨量减少可能发生或持续存在，而与免疫激活和骨转换改变无关。
