Bone mineral density in children and adolescents with perinatal HIV infection

Linda A. DiMeglio, Jiajia Wang, George K. Siberry, Tracie L. Miller, Mitchell E. Geffner, Rohan Hazra, William Borkowsky, Janet S. Chen, Laurie Dooley, Kunjal Patel, Russell B. Van Dyke, Roger A. Fielding, Yared Gurmu, Denise L. Jacobson

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To estimate prevalence of low bone mineral density (BMD) in perinatally HIV-infected (HIV+) and HIV-exposed but uninfected (HEU) children, and to determine predictors of BMD in HIV+. DESIGN: Cross-sectional analysis within a 15-site United States and Puerto Rico cohort study. METHODS: Total body and lumbar spine BMD were measured using dual energy-X-ray absorptiometry. BMD Z-scores accounted for bone age and sex. Multiple linear regression was used to evaluate differences in Z-scores by HIV status and for predictors of BMD in HIV+. RESULTS: 350 HIV+ and 160 HEU were enrolled. Mean age was 12.6 and 10.7 years for HIV+ and HEU, respectively. Most (87%) HIV+ were receiving HAART. More HIV+ than HEU had total body and lumbar spine Z-scores less than -2.0 (total body: 7 vs. 1%, P=0.008; lumbar spine: 4 vs. 1%, P=0.08). Average differences in Z-scores between HIV+ and HEU were attenuated after height and/or weight adjustment. Among HIV+, total body Z-scores were lower in those with higher CD4% and in those who ever used boosted protease inhibitors or lamivudine. Lumbar spine Z-scores were lower with higher peak viral load and CD4%, more years on HAART, and ever use of indinavir. CONCLUSION: Rates of low BMD in HIV+ children were greater than expected based on normal population distributions. These differences were partially explained by delays in growth. As most HIV+ children in this study had not entered their pubertal growth spurt, prepubertal factors associated with BMD, magnified or carried forward, may result in sub-optimal peak BMD in adulthood.

Original languageEnglish (US)
Pages (from-to)211-220
Number of pages10
Issue number2
StatePublished - Jan 14 2013
Externally publishedYes


  • CD4
  • HIV
  • antiretroviral agents
  • bone age
  • bone mineral density
  • children
  • viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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