1. IS THE BONE HEALTH OF HIV INFECTED CHILDREN AND ADOLESCENTS COMPROMISED?
A substudy of CARMA, the CIHR emerging team grant "Mechanism of aging following exposure to HIV antiretroviral drugs."
Both HIV and the antiretrovirals are suspected to affect the acquisition of bone mass, raising concerns about bone strength and fracture risk.
We have completed year 1 of this 3-year longitudinal study involving HIV infected children in BC (approximately 30). The objectives are to:
a. Determine whether HIV infected children have low bone mass compared to a healthy local population, using DXA (Dual-Energy X-ray Absorptiometry)
b. Assess bone strength using pQCT (peripheral quantitative computed tomography, a novel scanning technology
c. Determine the role of calcium and vitamin D intake, physical activity, muscle power, severity of disease and HIV medications on bone mass and bone strength.
Results are compared to an existing group of healthy BC children.
This study will set the basis for a multicentre study and for clinical guidelines for assessment and intervention.
2. CANADIAN PERINATAL HIV SURVEILLANCE PROGRAM (CPHSP)
in collaboration with the Canadian HIV Trials Network (CTN) and Public Health Agency of Canada (PHAC).
This web-based database collects data from 21 pediatric sites covering all Canadian provinces and territories.
The program generates descriptive data annually on:
A. HIV exposed children:
• the number of infants born to HIV positive women in Canada
• demographic, geographic and risk factor parameters of mother-infant pairs
• the use of antiretroviral therapy (ART) in pregnancy (proportion of HIV+ pregnant women receiving ART, type and duration of ART in mother and infant)
• the rate of mother-to-child HIV transmission
• infant outcomes (mortality)
B. HIV infected children:
•the number of known perinatally infected infants and children followed at the centres
•annual update on their clinical status, immune status and mortality
3. LONG TERM HEALTH OUTCOMES OF HIV UNINFECTED CHILDREN BORN TO HIV INFECTED MOTHERS
This study explores the accessibility of the BC cohort and examines the longer term health outcomes of HIV negative children exposed to antiretroviral therapy perinatally using a health questionnaire and by contact with their past or current health care professionals.
At the end of this pilot project, based on study outcomes, we will develop and implement a comprehensive and outcome oriented study exploring:
• the incidence of poor health outcomes such as growth abnormalities, susceptibility to infection, admissions to hospital, significant developmental disorders, poor scholastic performance, interaction with law enforcement, etc. in ARV exposed children compared to a age, sex and socio-economic status (parental education, household income and first 3 digits of postal code) matched control population;
• the association between length and type of ARV exposure and specific poor health outcomes;
• a comparison with the health outcomes of uninfected ARV exposed children from BC and three other pediatric HIV referral centres in Canada.
We hypothesize that, compared to all British Columbian children, HIV-uninfected, ARV exposed children will have a higher frequency of poor health outcomes such as described above. Enrolment is 95% complete. This pilot of British Columbia HIV/ARV exposed children is largely hypothesis generating and will guide the development of a larger multi-centred project.