Bhise Shruti, Jain Ashish, Savardekar Lalita, Shetty Naman S, Shah Ira
Department of Pediatrics, Pediatric HIV Clinic, B J Wadia Hospital for Children, Mumbai, Maharashtra, India.
Department of Clinical Research, Bone Health Clinic, ICMR National Institute of Research in Reproductive Health, Mumbai, Maharashtra, India.
Indian J Sex Transm Dis AIDS. 2021 Jul-Dec;42(2):138-143. doi: 10.4103/ijstd.IJSTD_35_19. Epub 2021 Oct 20.
The aim of this study is to determine the bone health in HIV-infected children on antiretroviral therapy (ART).
This cross-sectional study was carried out in 31 HIV-infected children aged 5-18 years. Each patient underwent testing for serum calcium, phosphorous, alkaline phosphatase, and 25(OH) Vitamin D. Bone mineral density (BMD) was done using a DXA scanner. Patients' z scores for BMD of the lumbar spine and left femoral neck were noted. The factors associated with low BMD were analyzed.
Seven (22.6%) children had a low spinal BMD and 6 (19.4%) had low femoral neck BMD. Low serum calcium was seen in 6 (19.4%) patients and high alkaline phosphatase was seen in 15 (48.4%) patients. Low serum 25 (OH) Vitamin D levels were present in 30 (96.8%) patients, whereas all the patients had normal serum phosphorous. Duration of ART in those with low spinal BMD was 4.6 ± 3.4 years as compared to 6.4 ± 3.2 years in those with normal spinal BMD ( = 0.235) and for low left femoral neck BMD was 3.9 ± 2 years as compared to 6.5 ± 3.4 years for those with normal femoral neck BMD ( = 0.031). Mean 25(OH) Vitamin D levels were 8.4 ± 2.8 ng/ml in those with low femoral neck BMD as compared to 13.6 ± 8.3 ng/ml in those with normal femoral neck BMD ( = 0.015). Type of ART did not have any association with low BMD.
Over 95% of HIV-infected children have low 25(OH) Vitamin D levels which affect the appendicular BMD. BMD is affected more in children who have been on ART for a shorter time. No particular ART regimen is associated with low BMD.
本研究旨在确定接受抗逆转录病毒治疗（ART）的HIV感染儿童的骨骼健康状况。
本横断面研究纳入了31名年龄在5至18岁的HIV感染儿童。每位患者均接受了血清钙、磷、碱性磷酸酶和25（OH）维生素D检测。使用双能X线吸收仪（DXA）测定骨密度（BMD）。记录患者腰椎和左股骨颈BMD的z评分。分析与低骨密度相关的因素。
7名（22.6%）儿童腰椎BMD较低，6名（19.4%）儿童股骨颈BMD较低。6名（19.4%）患者血清钙水平较低，15名（48.4%）患者碱性磷酸酶水平较高。30名（96.8%）患者血清25（OH）维生素D水平较低，而所有患者血清磷均正常。腰椎BMD较低者的ART疗程为4.6±3.4年，而腰椎BMD正常者为6.4±3.2年（P=0.235）；左股骨颈BMD较低者的ART疗程为3.9±2年，而股骨颈BMD正常者为6.5±3.4年（P=0.031）。股骨颈BMD较低者的平均25（OH）维生素D水平为8.4±2.8 ng/ml，而股骨颈BMD正常者为13.6±8.3 ng/ml（P=0.015）。ART类型与低骨密度无任何关联。
超过95%的HIV感染儿童25（OH）维生素D水平较低，这会影响四肢骨的骨密度。接受ART时间较短的儿童骨密度受影响更大。没有特定的ART方案与低骨密度相关。
