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Longitudinal Changes of Bone Mineral Density and Metabolism in Antiretroviral-Treated Human Immunodeficiency Virus-Infected Children

Laboratory of Pediatric Endocrinology (S.M., I.Z.), Scientific Institute H San Raffaele, Milan, 20132 Italy; and Chair of Pediatrics (S.B., R.B., V.G., A.V.), L. Sacco Hospital, Milan, Italy

Address all correspondence and requests for reprints to: Stefano Mora, M.D., Laboratory of Pediatric Endocrinology, H San Raffaele, Via Olgettina 60, 20132 Milano MI, Italy. E-mail: mora.stefano{at}hsr.it.

Highly active antiretroviral therapy (HAART) may be a contributory factor for a decreased bone mass and altered bone metabolism in HIV-infected children. However, the evolution of bone mineral density (BMD) and bone metabolism during HAART has not been studied yet. In the current longitudinal study we monitored the changes of BMD and bone metabolism over a period of 12 months. Thirty-two HIV-infected children (15 girls and 17 boys), aged from 6.3 to 17.7 yr, with a long duration of HAART exposure (40.0 months at baseline) were enrolled in the study. As a control group, 381 healthy volunteers of comparable age were assessed. BMD was measured at the lumbar spine and whole skeleton by dual-energy x-ray absorptiometry. Bone-specific alkaline phosphatase (BALP, as bone formation index) and N-terminal telopeptide of type I collagen (as bone resorption index) were measured in serum and urine, respectively. BMD values at baseline were significantly lower at all skeletal sites than those of control subjects. The annual increment of spine BMD was comparable to normal, whereas that of the whole skeleton was significantly lower (P < 0.04). BALP and N-terminal telopeptide of type I collagen concentrations were significantly higher compared with controls at baseline and at follow-up. BALP annual changes of HIV patients were significantly different from normal. Our data confirm the presence of low BMD and bone metabolism derangement in HIV-infected children treated with HAART. The role of possible therapeutic approach to restore bone mass and metabolism should be assessed in pediatrics.

This work was supported by Grant 30D.84 from Istituto Superiore di Sanità ‘Programma Nazionale di Ricerca sull’AIDS 2000'. I.Z. was supported by a fellowship from Fondazione Carlo Erba (Milan, Italy).

Abbreviations: BALP, Bone-specific alkaline phosphatase; BCE, bone collagen equivalents; BMD, bone mineral density; CV, coefficient of variation; HAART, highly active antiretroviral therapy; PI, protease inhibitor; sBMD, spinal BMD.

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