Jeena Lisha, Ferrand Rashida A, Simms Victoria, Kahari Cynthia, Bandason Tsitsi, Rukuni Ruramayi, Rehman Andrea M, Rowland-Jones Sarah, Hsieh Anthony Y Y, Gregson Celia L
Oxford Centre for Immuno-Oncology, Nuffield Department of Medicine, University of Oxford, Oxford.
Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
AIDS. 2025 May 1;39(6):683-694. doi: 10.1097/QAD.0000000000004134. Epub 2025 Feb 27.
To investigate bone density accrual over 1 year among peripubertal children with HIV (CWH) compared to children without infection (CWOH); and risk factors associated with bone density accrual among CWH.
A prospective cohort study in urban Zimbabwe.
CWH on antiretroviral therapy aged 8-16 years, and CWOH, frequency-matched by age were recruited in Zimbabwe. Z -scores for height-adjusted total-body less-head bone mineral content for lean mass (TBLH-BMC LBM ) and size-adjusted lumbar spine bone mineral apparent density (LS-BMAD) were calculated from dual X-ray absorptiometry (DXA) scan measurements. Linear regression compared bone density accrual by HIV status.
Of 609 participants, 492 (80.7%) completed a follow-up visit (50.2% boys, 49.6% CWH). Mean baseline age was 12.5 years. More girl CWH than CWOH were in Tanner stages I/II at baseline. Bone density accrual (Δ) adjusted for age, Tanner stage and baseline DXA Z -score was less in boy CWH than boy CWOH {adjusted mean (95% confidence interval (CI)] ΔLS-BMAD Z -score -0.14 (-0.25 to -0.02) vs. 0.01 (-0.09 to 0.12), P = 0.020, and ΔTBLH-BMC LBMZ -score -0.19 (-0.33 to -0.04) vs. 0.07 (-0.07 to 0.20), P = 0.015}, but similar in girls with and without HIV [ΔLS-BMAD Z -score 0.05 (-0.07 to 0.17) vs. -0.01 (-0.09 to 0.07), P = 0.416, and ΔTBLH-BMC LBMZ -score 0.08 (-0.07 to 0.22) vs. -0.03 (-0.12 to 0.07), P = 0.295]. Viral load greater than 1000 copies/ml and tenofovir disoproxil fumarate use were associated with less gain in LS-BMAD Z -score among boys, whereas Tanner stage IV and V were associated with greater gains in LS-BMAD and TBLH-BMC LBMZ -scores among CWH.
Among boys only, CWH had impaired bone accrual, associated with high viral load and tenofovir use. Bone density gains were greater in later puberty among CWH suggesting potential to correct deficits.
调查青春期前后感染人类免疫缺陷病毒（HIV）的儿童（CWH）与未感染儿童（CWOH）相比，1年内的骨密度增长情况；以及CWH中与骨密度增长相关的危险因素。
在津巴布韦城市进行的一项前瞻性队列研究。
在津巴布韦招募接受抗逆转录病毒治疗的8至16岁CWH以及按年龄频率匹配的CWOH。通过双能X线吸收测定法（DXA）扫描测量计算出身高调整后的全身除头瘦体重骨矿物质含量（TBLH-BMC LBM）的Z评分和大小调整后的腰椎骨矿物质表观密度（LS-BMAD）。线性回归比较了按HIV状态划分的骨密度增长情况。
609名参与者中，492名（80.7%）完成了随访（50.2%为男孩，49.6%为CWH）。平均基线年龄为12.5岁。基线时处于坦纳I/II期的CWH女孩比CWOH女孩更多。在对年龄、坦纳分期和基线DXA Z评分进行调整后，男孩CWH的骨密度增长（Δ）低于男孩CWOH{调整后均值（95%置信区间[CI]）：ΔLS-BMAD Z评分-0.14（-0.25至-0.02）对0.01（-0.09至0.12），P = 0.020；ΔTBLH-BMC LBMZ评分-0.19（-0.33至-0.04）对0.07（-0.07至0.20），P = 0.015}，但感染HIV和未感染HIV的女孩相似[ΔLS-BMAD Z评分0.05（-0.07至0.17）对-0.01（-0.09至0.07），P = 0.416；ΔTBLH-BMC LBMZ评分0.08（-0.07至0.22）对-0.03（-0.12至0.07），P = 0.295]。病毒载量大于1000拷贝/ml和使用替诺福韦酯与男孩LS-BMAD Z评分增长较少相关，而坦纳IV期和V期与CWH中LS-BMAD和TBLH-BMC LBMZ评分增长较多相关。
仅在男孩中，CWH的骨生长受损，与高病毒载量和使用替诺福韦有关。CWH在青春期后期的骨密度增加更大，提示有纠正缺陷的潜力。
