Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
Management of Medication Toxicity or Intolerance
Osteopenia and Osteoporosis
Last Updated: April 27, 2017; Last Reviewed: April 27, 2017
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Osteopenia and Osteoporosis||Any ART regimen
Specific Agents of Possible Concern:
||BMD z Score Less Than -2.0:
||Longer duration and greater severity of HIV disease
Growth or pubertal delay
Prolonged systemic corticosteroid use
Limited weight-bearing exercise
||Same options as for prevention.
Consider change in ARV regimen (e.g., changing TDF to TAF).
Role of bisphosphonates not established in children with HIV infection.
|a Some experts would periodically measure 25-OH-vitamin D, especially in HIV-infected urban youth, because in that population, the prevalence of vitamin D insufficiency is high.
b Until more data are available about the long-term effects of TDF on bone mineral acquisition in childhood, some experts would obtain a DXA at baseline and every 6 to 12 months for prepubertal children and children in early puberty who are initiating treatment with TDF. DXA could also be considered in adolescent women on TDF and medroxyprogesterone and in children with indications 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; DXA = dual-energy x-ray absorptiometry; LPV/r = lopinavir/ritonavir; PI = protease inhibitor; TDF = tenofovir disoproxil fumarate, TAF= tenofovir alafenamide
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