Puberty delayed in vertically infected children

Many chronic childhood illnesses are accompanied by delayed sexual maturation. A study published in AIDS (August 17th) by Martino and colleagues, from the University of Florence reports delayed puberty in perinatally infected HIV positive children.

Historically data is scarce concerning sexual maturation in this population due to insufficient numbers of children having reached the appropriate age for onset of puberty.

In this study Professor Martino’s group followed a cohort of 212 perinatally HIV-1 infected children – 107 girls and 105 boys, from 8 to 15.8 and 9 to 16.1 years old respectively. They reported that using Tanner pubertal stages to define sexual maturation (compared to a reference group of HIV-1 uninfected children), the median onset of puberty is delayed by about 2 years in girls and 1 year in boys. This delay was found to increase through each Tanner stage, increasing to about 2.5 years in girls and 1.5 years in boys in the later stages. These results are similar to those described for other chronic childhood diseases.

Another finding from this study is that this delay is independent of the weight for height, clinical condition or immunological condition at age of entry to puberty. In addition the delay in sexual maturity is greater in girls than in boys. Compared to boys girls have approximately 1 year greater delay in the onset and a further 6 months delay during puberty.

The authors report that currently the mechanisms that lead to delayed development and sexual maturation in HIV-1 infected are unknown and they add that ‘understanding the mechanisms by which HIV-1 interferes with sexual maturation may shed light on the physiology of the pubertal process itself’ and that ‘a deeper knowledge of the mechanisms that lead to delayed puberty could guide development-promoting strategies, saving much psychological distress for these adolescents’, they continue that ‘better understanding of the mechanisms leading to delayed puberty in girls and boys with perinatally acquired HIV-1 infection might lead to appropriate treatment when required.’

This is a very real cause for concern to many teenage patients, and some experience is beginning to be accumulated in the use of ethinyloestradiol to trigger puberty in girls with delayed puberty. The only intervention used so far in boys in a large London clinic has been to DELAY puberty in one eight year old with precocious puberty!