Bone mineral loss through increased bone turnover in HIV-infected childrentreated with highly active antiretroviral therapy

Objectives: To evaluate the occurrence and define the aetiology of osteopen ia in children receiving highly active antiretroviral therapy (HAART). Methods: Bone mineral density (BMD) of total body and lumbar spine (L2-L4) was assessed by dual-energy X-ray absorptiometry in 40 children vertically infected with HIV: 35 taking HAART and five naive to any antiretroviral tre atment (untreated). Six HAART-treated children showed clinical evidence of lipodystrophy. N-terminal propeptide of type-I procollagen (PINP), bone-spe cific alkaline phosphatase (BALP) and N-terminal telopeptide of type I coll agen (NTx) were measured. Results were compared with those obtained in 314 healthy controls. Differences between HIV-positive and healthy children and within the HIV-positive group were assessed by multivariate analyses, cont rolling for confounding variables (age, sex, weight and height). Results: HAART-treated children showed lower spine BMD values than untreate d (P = 0.045) and healthy (P = 0.004) children and lower total body BMD val ues than untreated (P = 0.012) and healthy (P < 0.0001) children. Spine and total body BMD were similar between untreated and healthy children. Total body BMD was lower (P < 0.005) in HAART-treated children with lipodystrophy than in untreated patients, while children on HAART but without lipodystro phy had intermediate values. BALP, PINP and NTx were similar among untreate d and healthy children. HAART-treated children had higher BALP levels than healthy (P = 0.0007) and untreated (P = 0.045) children. PINP values showed the same trend as BALP. HAART-treated children had higher NTx urine levels than healthy (P < 0.0001) and untreated (P = 0.041) children. Conclusions: HAART seems a new risk factor for life-long osteoporosis in ch ildren. An increased rate of bone turnover causes BMD decrease. Severity of osteopenia seems to be related to lipodystrophy. (C) 2001 Lippincott Willi ams & Wilkins.