Longitudinal bone evaluation in HIV - 1 vertically infected patients . A study from childhood to early adult age

Since the introduction of combined antiretroviral (cART), life expectancy of HIV-1 infected patients increased up to be comparable to non-HIV-1 infected population. Several studies reported early occurrence of aging-related effects in HIV-1 infected patient such as reduced bone quality and osteoporosis1-5. This condition is currently considered the result of the interplay among host, HIV-related chronic inflammation, and antiretroviral therapy, and may correspond to an increased risk from bone fracture5,6. Moreover, previous studies indicated that RANKL/OPG ratio resulted elevated during HIV infection for increased bone ABSTRACT: — Introduction: The present study aimed at evaluating the role of HIV infection and antiretroviral treatment on bone status through a longitudinal observational study based on a confrontation between two cohorts of HIV-1 vertically infected patients followed from childhood to adulthood. — Materials and Methods: We enrolled all patients with vertical HIV-1 infection who attended our hospital. Every patient was taking cART throughout the observation period. QUS variables AD-SoS and BTT were used to assess bone status. RANKL and OPG measurements were performed during treatment. Height, weight, BMI, pubertal stages and bone age were also determined. Longitudinal trend of HIVRNA and CD4 count and percentage were evaluated. 26 patients have a history of more than one virological failure, 21 patients have at most one virological failure. — Results: 47 patients were studied (23 males). Observations per patient ranged from 3 to 10 (123 observations for females and 122 for males). At baseline, mean age and SD were 10.9±4.6 years in females and 11.3±4.4 years in males. QUS values were reduced in HIV-infected youths, mainly in females. Mean ADSoS and BTT Z-scores were lower in patients with a history of more than one virological failure than in subjects with sustained viral load suppression. ADSoS, but not BTT mean values, were significantly lower in subjects with absolute CD4 lymphocyte count persistently <500 cells/ml than in subjects with CD4 T-lymphocyte count >500 cells/ml. RANKL/OPG ratio, AD-SoS SDS and BTT SDS were not related. — Conclusions: This longitudinal study provides the opportunity to evaluate the effects of HIV vertical infection on bone status. A non-invasive technique like QUS allowed to follow bone mass acquisition during growth.