Stephen M Arpadi, Stephanie Shiau, Charlotte Marx-Arpadi and Michael T Yin
Background: Children and adolescent, who acquire HIV infection early in life either perinatally, from contaminated blood products or via sexual transmission, have the greatest cumulative exposure to the negative direct and indirect effects of HIV infection and ART on bone. This may lead to increased lifetime risk for osteoporosis and fracture. We conducted a systematic review to evaluate the literature on bone health in children and adolescents with HIV. Methods: We performed a comprehensive search of the Medline, Scopus, and Cochrane Library databases (up to April 1, 2014) for studies that reported on bone imaging or bone fractures in HIV-infected children, adolescents, or young adults. Results: A total of 32 publications met our inclusion criteria. Seventeen studies were cross-sectional and 15 were longitudinal. The majority of studies were conducted in high-income countries, three in middle-income countries and none in low-income countries. Overall, the studies we reviewed indicate that measures of bone mass are reduced, with increased prevalence of low BMD in children and adolescents with HIV. However, the studies are highly variable with respect to comparison sources, measurement methods, adjustment techniques for body size or growth retardation, and highlighted risk factors, including aspects related to medication exposures as well as the effects of HIV infection per se. Conclusions: HIV infection appears to be associated with decreased bone accrual throughout childhood and adolescence. Sub-optimal bone accrual may persist through childhood and adolescence and result in reduced peak bone mass, an important determinant of future risk of osteoporosis and fracture. Important areas for future research include evaluation of bone mass, bone quality and fracture risk across the life course among those with early-life infection with HIV, particularly in resource-limited settings where the majority of children with HIV live.
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