Immunosuppressed, HIV-positive children who were infected with the virus at birth enter puberty later than HIV-negative children, according to US research published in the May 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Later onset of puberty has been noted in children with diseases such as leukemia and cystic fibrosis, and children with haeomophila who were infected with HIV by blood products have also been found to start puberty later.
Investigators in the US looked at the pubertal development of 983 children infected with HIV from birth involved in the Pediatric AIDS Clinical Trials Group (PACTG) 219 protocol. The aim of the study was to establish if severe immune suppression delayed the onset of sexual development. Children in the study were aged between six and 18 years and had two assessments of their pubertal development. The study ran from 1995 to 2000.
Pubertal development in boys was graded between one and five on the Tanner scale, which assigns a score to the sexual maturity of genitals, with one being prepubescent and five fully sexually mature. Investigators also recorded the development of breast size in girls and the growth of pubic hair in both girls and boys. The results were then compared with a study looking at the pubertal development of HIV-negative children in the USA.
Children were considered to have normal immune function if they had a CD4 cell percentage of at least 25% and severely immune depressed if their CD4 cell percentage fell below 15%. Information on HIV-related opportunistic infections was also recorded. To see if treatment with HAART had an impact on puberty, HIV treatment histories were obtained. Body mass index was also monitored. Racial origin was also noted.
Half the study sample were boys, and 58% were aged below eight years at baseline. Immune function (CD4 percentage above 25%) was reasonably intact in 49% of the patients, but severely depressed (CD4 percentage below 15%) in 27%. Most of the children were black (52%), a third were of Hispanic origin and 14% were white.
At baseline, 78 girls (16%) and 58 boys (12%) had evidence of pubertal development. Of the children with no evidence of puberty at baseline, 185 girls (45%) and 144 boys (33%), commenced puberty during follow-up. Investigators calculated that the girls in the study commenced puberty at an average age of 10.7 years, approximately one year before boys.
Both boys and girls with immune suppression were found to become pubescent later. For girls with good immune function (a CD4 percentage above 25%), the average age of puberty was 10.2 years, compared to 10.8 years for those with some degree of immune damage (a CD4 cell percentage below 25%), and 10.9 years for girls with severe immune suppression (a CD4 cell percentage of 15% or below). The same trend was also observed in boys, with puberty occurring earlier, average 10.9 years of age, in those with good immune function, and at 11.7 years in boys with some immune damage, and 11.5 years in those boys with severe immune suppression.
In a longitudinal analysis, which also included the children who did not enter puberty during the course of the study, the investigators found that in addition to immune function, higher body mass index and being of black race were also associated with earlier onset of sexual maturity in girls.
In addition to good immune function, Hispanic and/or African-American origin were associated with earlier sexual development in boys. Use of protease inhibitors was also moderately associated with earlier sexual development in boys, however no link was found with body mass index. A history of opportunistic infections was not found to delay puberty in either girls or boys.
When investigators compared their finding to the NHANES III data on the general pubertal development of US children, they found that in both girls and boys, breast development, genital maturity, and pubic hair growth occurred later in those infected with HIV.
The investigators note that their findings “are consistent with the notion that HIV disease affects production or secretion of hormones that regulate or directly control pubertal development.” They suggest that HIV-positive children experiencing delayed puberty may need psychological support “and may benefit from low doses of gonadal steroid hormones or growth hormones.”
Further information on this website
Buchacz K et al. Delayed onset of pubertal development in children and adolescents with perinatally acquired HIV infection. JAIDS, 33: 56 – 65, 2003.