儿童和青少年艾滋病患者的骨折问题。
Fractures in children and adolescents living with perinatally acquired HIV.
机构信息
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, USA.
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, USA.
出版信息
Bone. 2020 Oct;139:115515. doi: 10.1016/j.bone.2020.115515. Epub 2020 Jun 30.
BACKGROUND
Across numerous settings, bone mineral density for age and sex is lower in children/adolescents living with perinatally-acquired HIV (PHIV) compared to uninfected peers. We assessed incidences of any fracture/any long bone fracture, and osteoporosis prevalence in PHIV and HIV-exposed uninfected (PHEU) participants in the Pediatric HIV/AIDS Cohort Study (PHACS).
METHODOLOGY
Lifetime history of fracture events from birth up to age 20 years was obtained by chart review and/or interview, including age at fracture, mechanism, and bone(s) fractured. Poisson regression models were fit comparing fracture incidence by HIV status adjusted for age, sex, and race, with effect modification by age (<6, ≥6 yr).
RESULTS
PHIV (N = 412) were older (median 17.5 vs 16.7 yr) and more frequently reported black race (72% vs 61%) than PHEU children/adolescents (N = 206). 17% of PHIV and 12% of PHEU ever reported a fracture. Among children <6 yr, the adjusted incidence rate ratio of ≥1 fracture was higher (7.23; 95% CI 0.98, 53.51) in PHIV than PHEU, but similar among children/adolescents ≥6 years (1.20; 95% CI: 0.77, 1.87). Results were similar for long bone fracture. The most common fracture mechanisms were falling to the ground from a standing height (23.6% PHIV vs 8.8% PHEU) and sports injuries (21.3% vs 32.4%), and the most commonly fractured sites were the forearm and small bones of the wrist/hands. None of the children had osteoporosis.
CONCLUSIONS
Among children/adolescents ≥6 yr of age, fractures were similar by perinatal HIV status. Prospective, targeted collection of fracture history will be necessary to determine rates of fracture as PHIV and PHEU age into adulthood.
SUMMARY
Lifetime fracture history was collected in children/adolescents living with perinatally-acquired HIV (PHIV) and HIV-exposed uninfected (PHEU) children from birth up to age 20 years. Fracture incidence was higher in PHIV compared to PHEU among children <6 years old, but not among older children/adolescents.
背景
在许多环境中，与未感染 HIV 的同龄人相比，感染围生期 HIV（PHIV）的儿童和青少年的骨密度（按年龄和性别计算）较低。我们评估了 PHIV 和 HIV 暴露未感染（PHEU）参与者在儿科 HIV/AIDS 队列研究（PHACS）中发生任何骨折/长骨骨折以及骨质疏松症的发生率。
方法
通过病历回顾和/或访谈获得从出生到 20 岁的骨折事件终生史，包括骨折年龄、机制和骨折部位。使用泊松回归模型比较按 HIV 状态调整年龄、性别和种族后的骨折发生率，年龄（<6 岁、≥6 岁）作为效应修饰因子。
结果
PHIV（N=412）年龄较大（中位数 17.5 岁比 16.7 岁），且报告黑种人（72%比 61%）的比例更高。17%的 PHIV 和 12%的 PHEU 曾报告有过骨折。在<6 岁的儿童中，PHIV 的调整后骨折发生率高于 PHEU（7.23；95%CI0.98，53.51），但≥6 岁的儿童和青少年相似（1.20；95%CI：0.77，1.87）。长骨骨折的结果相似。最常见的骨折机制是从站立高度坠落（PHIV 为 23.6%，PHEU 为 8.8%）和运动损伤（21.3%比 32.4%），最常见的骨折部位是前臂和手腕/手部的小骨。没有儿童患有骨质疏松症。
结论
在≥6 岁的儿童和青少年中，围产期 HIV 状况与骨折无差异。需要前瞻性、有针对性地收集骨折史，以确定 PHIV 和 PHEU 成年后骨折的发生率。
总结
从出生到 20 岁，对感染围生期 HIV（PHIV）和 HIV 暴露未感染（PHEU）的儿童和青少年进行了终生骨折史的收集。与 PHEU 相比，<6 岁的 PHIV 儿童骨折发生率较高，但≥6 岁的儿童和青少年则不然。
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