Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Management of Medication Toxicity or Intolerance
Osteopenia and Osteoporosis
Last Updated: April 16, 2019; Last Reviewed: April 16, 2019
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/Monitoring||Management|
|Osteopenia and Osteoporosis||Any ART regimen
Specific Agents of Concern:
||BMD z Score Less Than -2.0:
||Longer duration and greater severity of HIV disease
Vitamin D insufficiency/deficiency
Delayed growth or pubertal delay
Prolonged systemic corticosteroid use
Lack of weight-bearing exercise
||Same options as for prevention.
Consider changing the ARV regimen (e.g., switching from TDF to TAF, and/or from LPV/r to EFV or an un-boosted INSTI whenever possible).
Treat patient with vitamin D3 to raise serum 25-OH-vitamin D concentrations to >30 ng/mL. Vitamin D3 levels should be monitored in patients who are receiving a daily dose of vitamin D3 >4,000 IU.
The role of bisphosphonates in managing osteopenia and osteoporosis in children with HIV has not been established.
|a Some experts periodically measure 25-OH-vitamin D. This is especially important in children and adolescents with HIV who live in urban areas; the prevalence of vitamin D insufficiency is high in that population.
b Until more data are available on the long-term effects of TDF on bone mineral acquisition in childhood, DXA scanning is not usually recommended for children who are being treated with TDF. Obtaining a DXA could be considered for adolescent women who are receiving TDF and medroxyprogesterone and for children with indications that are not uniquely related to HIV infection (such as cerebral palsy).
Key to Acronyms: ART = antiretroviral therapy; ARV = antiretroviral; BMD = bone mineral density; BMI = body mass index; COBI = cobicistat; DXA = dual-energy x-ray absorptiometry; EFV = efavirenz; INSTI = integrase strand transfer inhibitor; IU = international unit; LPV/r = lopinavir/ritonavir; PI = protease inhibitor; RTV = ritonavir; TAF= tenofovir alafenamide; TDF = tenofovir disoproxil fumarate