Alterations in circulating osteoimmune factors may be responsible for high bone resorption rate in HIV-infected children and adolescents

Stefano Mora, Ilaria Zamproni, Laura Cafarelli, Vania Giacomet, Paola Erba, Gianvincenzo Zuccotti, Alessandra Viganò

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Bone metabolism derangements have been reported in HIV-infected children and adolescents. Nuclear factor kappa B ligand (RANKL) and osteoprotegerin potently stimulate and inhibit, respectively, osteoclast formation and activity. We investigated the possible role of RANKL and osteoprotegerin on bone metabolism alterations in paediatric patients. DESIGN: A prospective controlled longitudinal study. Measurements were obtained before and 6 months after switching antiretroviral regimen. METHODS: We studied 27 vertically HIV-infected children and adolescents (aged 4.9-17.3 years) on long-term HAART (70.1 ± 1.5 months). All patients received lamivudine, stavudine and one protease inhibitor (PI). During follow-up, the PI was replaced with efavirenz and stavudine with tenofovir. We also enrolled 336 healthy children, aged 4.8-17.9 years. Concentrations of bone-specific alkaline phosphatase (BALP), N-terminal telopeptide of type I collagen (NTx), RANKL, and osteoprotegerin were measured at baseline and 6 months after switching. RESULTS: BALP serum concentrations and NTx urine levels of HIV-infected patients were significantly higher than those of healthy children both at baseline and after 6 months (P <0.001). Baseline osteoprotegerin and RANKL concentrations of HIV-infected patients were significantly higher than in healthy children (P <0.0001). Both concentrations decreased after 6 months, and RANKL levels were no longer different to controls. At baseline the RANKL/osteoprotegerin ratio was significantly higher (P = 0.02) in HIV-infected children (0.27 ± 0.07) compared with healthy children (0.078 ± 0.01). CONCLUSION: A marked alteration in the RANKL/osteoprotegerin system is present in patients receiving PI-based HAART. Short-term data indicate that replacing stavudine and PI with tenofovir and efavirenz restores the RANKL/osteoprotegerin equilibrium, and may thus lead to a reduction in the bone resorption rate.

Original languageEnglish
Pages (from-to)1129-1135
Number of pages7
JournalAIDS (London, England)
Issue number9
Publication statusPublished - May 2007


  • Bone metabolism
  • Bone resorption
  • HIV-infected children
  • Osteoprotegerin
  • RANK ligand

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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