Clinical and metabolic presentation of the lipodystrophic syndrome in HIV-infected children.
OBJECTIVE
To investigate body fat distribution and glucose and lipid metabolism in HIV-infected children with the aim of describing the lipodystrophic syndrome in children.


METHODS
Cross-sectional study including 39 HIV-infected children aged 3-18 years.


METHODS
Clinical lipodystrophy was defined as peripheral fat wasting (facial and/or buttock and/or limb atrophy with arm skinfold thickness lower than the third percentile of the reference values for sex and age) and/or truncal adiposity (breast enlargement and/or buffalo neck and/or relative abdominal obesity with trunk : arm skinfold ratio > 2 standard deviations). Fasting serum lipid concentrations were measured and an oral glucose tolerance test was performed.


RESULTS
Of 39 HIV-infected children, lipodystrophy was observed in 13 children (33.3%): eight with truncal lipohypertrophy, three with peripheral lipoatrophy and two with combined lipodystrophy. Combined lipodystrophies were observed only in adolescents with a more severe presentation than in prepubertal children. Lipodystrophic children had higher fasting insulinaemia (7.0+/-8.5 versus 3.0+/-2.3 microU/ml; P = 0.07), suggesting a certain degree of insulin-resistance. Hypercholesterolaemia (23% versus 15%; P = 0.59 ) and hypertriglyceridaemia (15% versus 11%; P = 0.76) were observed with the same proportion in the lipodystrophic as in the non-lipodystrophic groups; 23% of the non-lipodystrophic children had dyslipidaemia.


CONCLUSIONS
The lipodystrophic syndrome prevails in HIV-infected children in the three clinical forms initially described in adults but appears less severe before the initiation of puberty. Insulin-resistance occurs in lipodystrophic children only, whereas dyslipidaemia exists in non-lipodystrophic children as well, suggesting that dyslipidaemia could reflect subclinical alteration of the adipose tissue.
Jaquet
D
D
INSERM Unit 457, Hôpital Robert Debré, Paris, France.
Lévine
M
M
Ortega-Rodriguez
E
E
Faye
A
A
Polak
M
M
Vilmer
E
E
Lévy-Marchal
C
C
D000293:Adolescent; D019380:Anti-HIV Agents / Q000009:adverse effects; D001823:Body Composition; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D006949:Hyperlipidemias / Q000139:chemically induced; D015228:Hypertriglyceridemia / Q000139:chemically induced; D007328:Insulin / Q000032:analysis; D008060:Lipodystrophy / Q000139:chemically induced / Q000503:physiopathology*; D008297:Male
D019380:Anti-HIV Agents; D007328:Insulin