Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
AIDS. 2023 Apr 1;37(5):759-767. doi: 10.1097/QAD.0000000000003477. Epub 2023 Feb 7.
HIV infection impairs bone density in children living with HIV (CLWH). We aimed to determine the prevalence of self-reported fracture (past or current), associated risk factors and disability, by HIV status in Zimbabwean children.
Cross-sectional study.
We recruited CLWH aged 8-16 years taking antiretroviral therapy (ART) for ≥2 years from HIV clinics, and HIV-uninfected children from schools in Harare. Interviewer-administered questionnaires collected data on fracture site and management, sociodemographics, dietary calcium and vitamin D, physical activity and HIV history. Dual-energy X-ray absorptiometry (DXA) measured size-adjusted bone density.
We recruited 303 CLWH [mean (SD) age 12.5 (2.5) years; 50% female] and 306 children without HIV [12.5 (2.5) years; 51% female]. Median age at HIV diagnosis in CLWH was 3.0 years [interquartile range (IQR) 1.2, 5.9], and median ART duration 8.1 years [IQR 6.2, 9.5]. 53.8% CLWH had self-reported disability and/or functional impairment, vs. 29.4% children without HIV. Fracture prevalence was 5.9% with no difference by HIV status [21/306 (6.9%) vs. 14/303 (4.6%), P = 0.24]. Male sex was associated with fractures. Low size-adjusted bone density ( Z -score < -2) was associated with prevalent fractures in CLWH {risk ratio [RR] 1.14 (95% confidence interval (CI) -0.02, 2.29]}, but not in children without HIV [RR -0.04 (-2.00, 1.91)], P -interaction = 0.27. All sought medical attention for their fracture(s), but CLWH were less often admitted to hospital [2/14 (14.3%) vs. 7/21 (33.3%)].
Prevalent fractures may be associated with low lumbar spine bone density in CLWH. Fracture surveillance and strategies to reduce future fracture risk are warranted as CLWH enter adulthood.
HIV 感染会损害 HIV 感染者（CLWH）的骨密度。本研究旨在确定津巴布韦儿童中，按 HIV 感染状态报告的骨折（过去或现在）发生率、相关危险因素和残疾情况。
横断面研究。
我们招募了在 HIV 诊所接受抗逆转录病毒治疗（ART）治疗时间≥2 年、年龄在 8-16 岁的 CLWH，并从哈拉雷的学校招募了未感染 HIV 的儿童。通过访谈者管理的问卷收集了骨折部位和管理情况、社会人口统计学、膳食钙和维生素 D、身体活动和 HIV 病史等数据。双能 X 线吸收法（DXA）测量了骨密度。
我们共招募了 303 名 CLWH[平均（SD）年龄 12.5（2.5）岁；50%为女性]和 306 名未感染 HIV 的儿童[12.5（2.5）岁；51%为女性]。CLWH 的 HIV 诊断中位年龄为 3.0 岁[四分位间距（IQR）1.2-5.9]，ART 中位治疗时间为 8.1 年[IQR 6.2-9.5]。53.8%的 CLWH 有残疾和/或功能障碍，而未感染 HIV 的儿童为 29.4%。骨折发生率为 5.9%，与 HIV 状态无关[21/306（6.9%）与 14/303（4.6%），P=0.24]。男性是骨折的危险因素。在 CLWH 中，低骨密度（Z 评分<-2）与现患骨折相关[风险比（RR）1.14（95%置信区间（CI）-0.02，2.29]，但在未感染 HIV 的儿童中无相关性[RR-0.04（-2.00，1.91）]，P 交互=0.27。所有骨折患者都寻求了医疗护理，但 CLWH 住院治疗的比例较低[14/21（66.7%）与 7/14（50.0%）]。
CLWH 现患骨折可能与腰椎骨密度低有关。随着 CLWH 进入成年期，需要对骨折进行监测，并制定策略以降低未来骨折风险。
