Sexual maturity staging and affecting immune-hormonal factors in children aged 6-18 years living with HIV: experience from tertiary care center in North India

Abstract

Background Children living with human immunodeficiency virus (HIV) may experience growth failure and delay in sexual maturation. The aim of the study was to investigate sexual maturity rating and hormonal levels in children living with HIV aged 6-18 years. Material and methods In this cross-sectional observational study over 18 months, 69 subsequent children living with HIV (CLHIV), aged between 6- and 18-years, attending antiretroviral therapy (ART) clinic were enrolled. Clearance from the Institutional Ethical Committee and informed consents were obtained. Results Baseline data of 69 children showed male predominance (66.7%), vertical transmission (95.7%), normal body mass index (BMI) (71%), immunocompetency (3/4th), and low viral load (2/3rd). Sexual maturity staging revealed that the majority were pre-pubertal (pubic hair (PH) stage 1: boys = 54.3%, girls = 39.1%; testicular volume stage 1 = half; breast stage 1 = 39.1%). Delayed puberty was observed in 6.5% of boys and 8.6% of girls. The mean age of menarche was 13 ± 1.4 years. Hormonal levels between boys and girls showed statistically significant difference in levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estrogen, and Free androgen index (FAI). Luteinizing hormone had high sensitivity and specificity (cut-off value = 1.06, sensitivity = 95.5%, specificity = 83.3%) for predicting stage 2 of testicular volume (gonadarche), and in girls (cut-off value = 1.74, sensitivity = 92.9%, specificity = 88.9%). For FSH in girls, cutoff value of 5.42 provided high sensitivity (92.9%) in predicting thelarche (breast stage 2). No statistically significant association was observed with CD4 categories (p = 0.3), viral load categories (p = 0.2), age at ART initiation, and BMI categories with pubertal stages. Among antiretroviral drugs, less than 50% of children on abacavir, zidovudine, and lopinavir/ritonavir had attained pubertal onset (in girls, breast stage ≥ 2; in boys, testicular volume (TV) stage ≥ 2). Conclusions Delayed puberty was observed in 6.5% of boys and 8.6% of girls. Median ages at thelarche and gonadarche were higher in included children when compared to healthy school going children. HIV infection may have a negative effect on the sexual maturity rating in CLHIV.

Keywords

• children living with hiv
• puberty
• tanner’s stages
• lh
• fsh
• testosterone