Bellavia, AndreaWilliams, Paige L.DiMeglio, Linda A.Hazra, RohanAbzug, Mark J.Patel, KunjalJacobson, Denise L.Van Dyke, Russell B.Geffner, Mitchell E.International Maternal Pediatric and Adolescent AIDS Clinical Trials (IMPAACT) P219/219C StudyPediatric HIV/AIDS Cohort Study (PHACS)2019-01-312019-01-312017-06-01Bellavia, A., Williams, P. L., DiMeglio, L. A., Hazra, R., Abzug, M. J., Patel, K., Jacobson, D. L., Van Dyke, R. B., Geffner, M. E., International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P219/219C Study, and the Pediatric HIV/AIDS Cohort Study (PHACS) (2017). Delay in sexual maturation in perinatally HIV-infected youths is mediated by poor growth. AIDS (London, England), 31(9), 1333-1341.https://hdl.handle.net/1805/18273OBJECTIVE: To evaluate the association between HIV infection and sexual maturation, and mediation of this association by HIV effects on growth. DESIGN: Pooled data were analyzed from two longitudinal cohort studies, the International Maternal Pediatric Adolescent AIDS Clinical Trials P219/219C Study (1993-2007) and the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (2007-2015), including perinatally HIV-infected (PHIV) and HIV-exposed uninfected (PHEU) youths. METHODS: We evaluated age at sexual maturity among 2539 PHIV and PHEU adolescents based on annual physician-assessed pubertal staging measures. Interval-censored regression models were used to evaluate associations of HIV infection with age at maturity. Mediation analyses accounting for height and BMI Z-scores at specific ages were used to estimate direct and indirect effects of HIV infection on age at sexual maturity. RESULTS: Mean ages at sexual maturity for PHIV girls (n = 1032) were 15.5 years for both female breast and pubic hair and 15.9 and 15.8 years for PHIV boys (n = 1054) for genitalia and pubic hair, respectively. PHIV youths matured approximately 6 months later on average than PHEU (n = 221 girls and 232 boys), and this difference persisted after adjustment for race/ethnicity and birth cohort. BMI and height Z-scores mediated the association between HIV infection and later maturation in girls, accounting for up to 74% of the total HIV effect. Only height Z-scores mediated the effect of HIV on male age at maturity, accounting for up to 98% of the HIV effect. CONCLUSION: PHIV youths attain sexual maturity later on average than PHEU youths. Much of this difference may be attributable to deficient growth, suggesting directions for future interventions.en-USPublisher PolicyPubertyGrowthHIVSexual maturityPerinatalMediationInterval-censoringArticle