TY - JOUR
T1 - Adverse bone health and abnormal bone turnover among perinatally HIV-infected Asian adolescents with virological suppression
AU - the Bone-D Study Group
AU - Sudjaritruk, T.
AU - Bunupuradah, T.
AU - Aurpibul, L.
AU - Kosalaraksa, P.
AU - Kurniati, N.
AU - Prasitsuebsai, W.
AU - Sophonphan, J.
AU - Sohn, A. H.
AU - Ananworanich, J.
AU - Puthanakit, T.
AU - Mangunkusumo, Cipto
AU - Wicaksana, P.
AU - Yawan, K.
AU - Thamsala, S.
AU - Pitimahajanaka, T.
AU - Suwanlerk, T.
AU - Thongpunchang, B.
AU - Ubolyam, S.
AU - Mahanontharit, A.
AU - Laopraynak, N.
AU - Jaimulwong, T.
AU - Chotecharoentanan, T.
AU - Khamrong, C.
AU - Wongnum, N.
AU - Rungruengthanakit, K.
AU - Suwannamas, N.
AU - Wongworapat, K.
AU - Sopharuk, C.
AU - Tharnprisan, P.
N1 - Funding Information:
The study team would like to thank participants and families for their participation in the study. The study team would also like to thank Dr Suparat Kanjanavanit, Dr Witaya Petdachai, and Dr Woraman Waidab for their support with the recruitment process. We are grateful to Dr Pairunyar Nakavachara for contributing a normal reference of bone mineral density in healthy Thai adolescents. The study team greatly appreciates the valuable suggestions and inputs of Dr David D. Celentano, Dr Andrea Ruff, Dr William J. Moss and Dr Todd T. Brown, who gave critical advice on research methodology and data interpretation. The following institutions, clinical site investigators, and staff participated in conducting the Bone-D study, in alphabetical order: Cipto Mangunkusumo General Hospital, Jakarta, Indonesia: P. Wicaksana; HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand: K. Yawan, S. Thamsala, T. Pitimahajanaka, T. Suwanlerk, B. Thongpunchang, S. Ubolyam, A. Mahanontharit, N. Laopraynak and T. Jaimulwong; Faculty of Medicine and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand: T. Chotecharoentanan, C. Khamrong, N. Wongnum, K. Rungruengthanakit, N. Suwannamas and K. Wongworapat; Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand: C. Sopharuk and P. Tharnprisan. Funding: The study was funded by TREAT Asia, a programme of The Foundation for AIDS Research (amfAR), with support from ViiV Healthcare. TS received funding from the National Research University Project under Thailand's Office of the Higher Education Commission. TP received funding through a Thailand Research Fund Institutional Grant (IRG5780015). Conflicts of interest: JA has received honoraria for advisory meeting participation from ViiV Healthcare, Merck and Tetralogic. All other authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2016 British HIV Association
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objectives: This study aimed to determine the prevalence of low bone mass and assess its relationship with abnormal bone turnover among HIV-infected Asian adolescents. Methods: A multicentre, cross-sectional study was conducted at four paediatric HIV centres in Thailand and Indonesia. Perinatally HIV-infected adolescents aged 10–18 years receiving antiretroviral therapy (ART) with virological suppression (HIV RNA < 400 copies/mL) were enrolled. Study assessments included lumbar spine (L2−L4) dual-energy X-ray absorptiometry and measurement of bone turnover markers. Bone mineral density (BMD) and bone mineral apparent density (BMAD) Z-scores were calculated based on Thai normative age- and sex-matched references. Low bone mass was defined as BMD or BMAD Z-scores ≤ −2. Results: Of 396 participants, 57% were female. The median age was 15.0 [interquartile range (IQR) 13.3–16.9] years, and 73% were in Tanner stage 3−5. At enrolment, the median CD4 T-cell count was 734 (IQR 581–907) cells/μL, and 37% were on protease inhibitor (PI)-based regimens. The overall prevalence of lumbar spine BMD and BMAD Z-scores ≤ −2 were 16.4% and 8.3%, respectively. Z-scores were lower with older age, female sex, body mass index (BMI) <5th percentile, boosted PI exposure and CD4 T-cell percentage < 15% before ART initiation. Increased bone turnover markers were inversely associated with BMD and BMAD Z-scores. Conclusions: Low bone mass was linked to older age, female sex, low BMI, boosted PI exposure, and poor immunological status before ART commencement in our cohort of perinatally HIV-infected Asian adolescents. Dysregulation of bone turnover was associated with bone demineralization. Screening for low bone mass should be implemented to identify individuals who might benefit from interventions to preserve bone health.
AB - Objectives: This study aimed to determine the prevalence of low bone mass and assess its relationship with abnormal bone turnover among HIV-infected Asian adolescents. Methods: A multicentre, cross-sectional study was conducted at four paediatric HIV centres in Thailand and Indonesia. Perinatally HIV-infected adolescents aged 10–18 years receiving antiretroviral therapy (ART) with virological suppression (HIV RNA < 400 copies/mL) were enrolled. Study assessments included lumbar spine (L2−L4) dual-energy X-ray absorptiometry and measurement of bone turnover markers. Bone mineral density (BMD) and bone mineral apparent density (BMAD) Z-scores were calculated based on Thai normative age- and sex-matched references. Low bone mass was defined as BMD or BMAD Z-scores ≤ −2. Results: Of 396 participants, 57% were female. The median age was 15.0 [interquartile range (IQR) 13.3–16.9] years, and 73% were in Tanner stage 3−5. At enrolment, the median CD4 T-cell count was 734 (IQR 581–907) cells/μL, and 37% were on protease inhibitor (PI)-based regimens. The overall prevalence of lumbar spine BMD and BMAD Z-scores ≤ −2 were 16.4% and 8.3%, respectively. Z-scores were lower with older age, female sex, body mass index (BMI) <5th percentile, boosted PI exposure and CD4 T-cell percentage < 15% before ART initiation. Increased bone turnover markers were inversely associated with BMD and BMAD Z-scores. Conclusions: Low bone mass was linked to older age, female sex, low BMI, boosted PI exposure, and poor immunological status before ART commencement in our cohort of perinatally HIV-infected Asian adolescents. Dysregulation of bone turnover was associated with bone demineralization. Screening for low bone mass should be implemented to identify individuals who might benefit from interventions to preserve bone health.
KW - bone mass
KW - bone mineral density
KW - bone remodelling
KW - dual energy X-ray absorptiometry
KW - perinatal HIV infection
UR - http://www.scopus.com/inward/record.url?scp=84994462061&partnerID=8YFLogxK
U2 - 10.1111/hiv.12418
DO - 10.1111/hiv.12418
M3 - Article
C2 - 27477214
AN - SCOPUS:84994462061
VL - 18
SP - 235
EP - 244
JO - HIV Medicine
JF - HIV Medicine
SN - 1464-2662
IS - 4
ER -