Bone health in HIV-infected children on antiretroviral therapy: An Indian study

Aim: The aim of this study is to determine the bone health in HIV-infected children on antiretroviral therapy (ART). Materials and Methods: This cross-sectional study was carried out in 31 HIV-infected children aged 5-18 years. Each patient underwent testing for serum calcium, phosphorous, alkaline phosphatase, and 25(OH) Vitamin D. Bone mineral density (BMD) was done using a DXA scanner. Patients' z scores for BMD of the lumbar spine and left femoral neck were noted. The factors associated with low BMD were analyzed. Results: Seven (22.6%) children had a low spinal BMD and 6 (19.4%) had low femoral neck BMD. Low serum calcium was seen in 6 (19.4%) patients and high alkaline phosphatase was seen in 15 (48.4%) patients. Low serum 25 (OH) Vitamin D levels were present in 30 (96.8%) patients, whereas all the patients had normal serum phosphorous. Duration of ART in those with low spinal BMD was 4.6 +/- 3.4 years as compared to 6.4 +/- 3.2 years in those with normal spinal BMD (P = 0.235) and for low left femoral neck BMD was 3.9 +/- 2 years as compared to 6.5 +/- 3.4 years for those with normal femoral neck BMD (P = 0.031). Mean 25(OH) Vitamin D levels were 8.4 +/- 2.8 ng/ml in those with low femoral neck BMD as compared to 13.6 +/- 8.3 ng/ml in those with normal femoral neck BMD (P = 0.015). Type of ART did not have any association with low BMD. Conclusion: Over 95% of HIV-infected children have low 25(OH) Vitamin D levels which affect the appendicular BMD. BMD is affected more in children who have been on ART for a shorter time. No particular ART regimen is associated with low BMD.