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J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):33-42. doi: 10.1097/QAI.0000000000001467.

Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children.

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*Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA;†USDA Western Human Nutrition Research Center, University of California, Davis, CA;‡Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine at the University of Miami, Miami, FL;§Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA;‖Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA;¶Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA;#Department of Pediatrics, University of Florida, Jacksonville, FL;**Nutrition Department, University of California, Davis, CA;††Maternal and Pediatric Infectious Disease (MPID) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD;‡‡Frontier Science & Technology Research Foundation, Amherst, NY;§§The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA;‖‖Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, CA; and¶¶Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.



Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual.


PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children.


PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children.


PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.

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