Growth and pubertal development in HIV-infected adolescents.
Growth and pubertal development in HIV-infected adolescents.
复制标题
DOI：
10.1097/coh.0000000000000450
复制
发表时间：
2018-05
影响因子：
4.1
通讯作者：
Jesson J
中科院分区：
文献类型：
--
作者：
Williams PL;Jesson J
我们提出了最近的研究综述在相互关联的领域的生长和青春期发展的青少年艾滋病毒。儿童早期的生长缺陷会导致青春期延迟，进而影响青春期的快速生长和骨骼健康。生长受损仍然是一个严重问题，特别是在资源匮乏的环境中，发育迟缓、消瘦和体重不足仍然普遍存在。开始抗逆转录病毒治疗（ART）可改善生长，头几年的生长恢复最大，体重的改善大于身高的改善。然而，即使在抗逆转录病毒治疗开始数年后，生长缺陷在低资源环境（LRS）中仍然存在，青少年的风险似乎尤其增加。发育迟缓的高发生率转化为青春期发病和性成熟的延迟。相比之下，发达国家感染艾滋病毒的青少年没有表现出持续的消瘦，但青春期发育仍然延迟。生长受损会增加死亡、病毒学失败和骨骼健康异常的风险，也会增加抑郁和耻辱感。不论免疫状况如何，所有年龄组尽早开始抗逆转录病毒治疗对于恢复生长至关重要。需要协调抗逆转录病毒治疗的启动、营养补充计划和同时预防，以改善生长缺陷和青春期延迟，特别是在LRS中。
We present an overview of recent research in the inter-related areas of growth and pubertal development among adolescents with HIV. Growth deficits early in childhood can lead to delayed puberty, with subsequent effects on pubertal growth spurts and bone health. Impaired growth remains a critical concern, particularly in low resource settings, where stunting, wasting and underweight remain pervasive. Antiretroviral treatment (ART) initiation results in improved growth, with greatest growth recovery in the first years and more improvement in weight than in height. However, even years after ART initiation, growth deficits persist in low resource settings (LRS), and adolescents appear at particularly increased risk. The high prevalence of stunting translates to delays in pubertal onset and sexual maturity. In contrast, HIV-infected adolescents in developed countries do not demonstrate persistent wasting, yet still have delayed pubertal development. Impaired growth increases the risk for mortality, virologic failure, and abnormal bone health, as well as increased depression and stigma. Early initiation of ART across all age groups regardless of immunological status is essential for restoring growth. Coordination of ART initiation, nutritional supplementation programs, and concurrent prophylaxis is required to ameliorate growth deficits and pubertal delays, particularly in LRS.