Endocrinological Abnormalities and Growth Impairment in Human Immunodeficiency Virus-Infected Children
07 April 2017
23 November 2017
16 January 2018 (eFirst)
Background Pediatric human immunodeficiency virus (HIV) is an important emerging disease and many children are surviving into adulthood with effective antiretroviral therapy. Growth dysregulation is common in these children and endocrine abnormalities are likely to be a possible comorbidity. There is a paucity of data on these endocrinological abnormalities in this population. Against this background, a study to evaluate the endocrinological profile in HIV-infected children and its relationship with growth failure was performed.
Methods A cross-sectional descriptive study was performed in children less than 18 years attending the pediatric HIV clinic at a tertiary care hospital in central India. Blood samples for T3, T4, thyroid-stimulating hormone (TSH), growth hormone (GH), dehydroepiandrosterone (DHEA), cortisol, and insulin-like growth factor-binding protein 3 (IGFBP3) were collected during routine visit, preserved at –70°C, and subsequently assayed. Statistical analysis for the data with respect to the endocrinological abnormalities and growth failure was performed.
Results A total of 100 children were included in the study. The prevalence of growth failure was high. Nineteen percent children had height less than − 3 standard deviation (SD) and 59% children had height less than 2SD. The prevalence of endocrinological abnormalities was also high. Fifty-four percent children had low T3 levels, 12% had low T4 levels, 4% had high TSH levels, 44% had low cortisol levels, and 25% had low DHEA. Fifty-eight percent children had low GH levels, while IGFBP3 levels were low in the entire cohort. There was a statistically significant association between growth failure and levels of T3 and GH.
Conclusion Our results show a high prevalence of growth failure and endocrinological abnormalities in HIV-infected children. A significant association between growth failure and endocrine abnormalities was found for T3 and GH.
- 1 UNAIDS. Global AIDS Update 2017; July 2017. UNAIDS. AIDSinfo website; accessed July 2017. Available at: http://aidsinfo.unaids.org/ . UNAIDS. Core Epidemiology Slides; June 2017
- 2 Arpadi SM. Growth failure in children with HIV infection. J Acquir Immune Defic Syndr 2000; 25 (Suppl. 01) S37-S42
- 3 Sinha U, Sengupta N, Mukhopadhyay P, Roy KS. Human immunodeficiency virus endocrinopathy. Indian J Endocrinol Metab 2011; 15 (04) 251-260
- 4 Isanaka S, Duggan C, Fawzi WW. Patterns of postnatal growth in HIV-infected and HIV-exposed children. Nutr Rev 2009; 67 (06) 343-359
- 5 Grinspoon SK, Bilezikian JP. HIV disease and the endocrine system. N Engl J Med 1992; 327 (19) 1360-1365
- 6 Chantry CJ, Frederick MM, Meyer III WA. , et al. Endocrine abnormalities and impaired growth in human immunodeficiency virus-infected children. Pediatr Infect Dis J 2007; 26 (01) 53-60
- 7 Jospe N, Powell KR. Growth hormone deficiency in an 8-year-old girl with human immunodeficiency virus infection. Pediatrics 1990; 86 (02) 309-312
- 8 Frost RA, Nachman SA, Lang CH, Gelato MC. Proteolysis of insulin-like growth factor-binding protein-3 in human immunodeficiency virus-positive children who fail to thrive. J Clin Endocrinol Metab 1996; 81 (08) 2957-2962
- 9 Chiarelli F, Galli L, Verrotti A, di Ricco L, Vierucci A, de Martino M. Thyroid function in children with perinatal human immunodeficiency virus type 1 infection. Thyroid 2000; 10 (06) 499-505
- 10 Rana S, Nunlee-Bland G, Valyasevi R, Iqbal M. Thyroid dysfunction in HIV-infected children: is L-thyroxine therapy beneficial?. Pediatr AIDS HIV Infect 1996; 7 (06) 424-428
- 11 Chiarelli F, Verrotti A, Galli L, Basciani F, de Martino M. Endocrine dysfunction in children with HIV-1 infection. J Pediatr Endocrinol Metab 1999; 12 (01) 17-26
- 12 Hirschfeld S. Dysregulation of growth and development in HIV-infected children. J Nutr 1996; 126 (10, Suppl): 2641S-2650S
- 13 William LR, Gwendolyn AM, Carl AB. , et al. Textbook of Clinical Chemistry and Molecular Diagnostics, 5th ed. Elsevier; 2012
- 14 Panamonta O, Kosalaraksa P, Thinkhamrop B, Kirdpon W, Ingchanin C, Lumbiganon P. Endocrine function in Thai children infected with human immunodeficiency virus. J Pediatr Endocrinol Metab 2004; 17 (01) 33-40
- 15 Matarazzo P, Palomba E, Lala R. , et al. Growth impairment, IGF I hyposecretion and thyroid dysfunction in children with perinatal HIV-1 infection. Acta Paediatr 1994; 83 (10) 1029-1034
- 16 Laue L, Pizzo PA, Butler K, Cutler Jr GB. Growth and neuroendocrine dysfunction in children with acquired immunodeficiency syndrome. J Pediatr 1990; 117 (04) 541-545
- 17 Lepage P, Van de Perre P, Van Vliet G. , et al. Clinical and endocrinologic manifestations in perinatally human immunodeficiency virus type 1--Infected children aged 5 years or older. Am J Dis Child 1991; 145 (11) 1248-1251
- 18 Rondanelli M, Caselli D, Aricò M. , et al. Insulin-like growth factor I (IGF-I) and IGF-binding protein 3 response to growth hormone is impaired in HIV-infected children. AIDS Res Hum Retroviruses 2002; 18 (05) 331-339
- 19 Lala R, Palomba E, Matarazzo P, Altare F, Tovo PA. ACTH and cortisol secretions in children with perinatal HIV-1 infection. Pediatr AIDS HIV Infect 1996; 7 (04) 243-245
- 20 Oberfield SE, Cowan L, Levine LS. , et al. Altered cortisol response and hippocampal atrophy in pediatric HIV disease. J Acquir Immune Defic Syndr 1994; 7 (01) 57-62
- 21 Colaco P, Desai M, Choksi CS. Short stature in Indian children: the extent of the problem. Indian J Pediatr 1991; 58 (Suppl. 01) 57-58
- 22 Khadgawat R, Dabadghao P, Mehrotra RN, Bhatia V. Growth charts suitable for evaluation of Indian children. Indian Pediatr 1998; 35 (09) 859-865
- 23 Garg P. Short stature in Indian children: experience from a community level hospital. Sri Lanka J Child Health 2004; 34: 84-88
- 24 Padmapriyadarsini C, Pooranagangadevi N, Chandrasekaran K. , et al. Prevalence of underweight, stunting, and wasting among children infected with human immunodeficiency virus in South India. Int J Pediatr 2009; DOI: http://dx.doi.org/10.1155/2009/837627.
- 25 Bailey RC, Kamenga MC, Nsuami MJ, Nieburg P, St Louis ME. Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo. Int J Epidemiol 1999; 28 (03) 532-540
- 26 Kawo G, Karlsson K, Lyamuya E. , et al. Prevalence of HIV type 1 infection, associated clinical features and mortality among hospitalized children in Dar es Salaam, Tanzania. Scand J Infect Dis 2000; 32 (04) 357-363
- 27 Chinkhumba J, Tomkins A, Banda T, Mkangama C, Fergusson P. The impact of HIV on mortality during in-patient rehabilitation of severely malnourished children in Malawi. Trans R Soc Trop Med Hyg 2008; 102 (07) 639-644
- 28 Rajasekaran S, Jeyaseelan L, Ravichandran N, Gomathi C, Thara F, Chandrasekar C. Efficacy of antiretroviral therapy program in children in India: prognostic factors and survival analysis. J Trop Pediatr 2009; 55 (04) 225-232