title: Longitudinal evaluation and risk factors of lipodystrophy and associated metabolic changes in HIV-infected children.
abstract: OBJECTIVE
  To assess the rate of progression of lipodystrophy and the associated metabolic disturbances over a 2-year period in children and to assess risk factors associated with lipodystrophy and metabolic disturbances.
  
  
  METHODS
  Multicenter 2-year prospective study with a standardized evaluation.
  
  
  METHODS
  One hundred thirty children (median age = 10 years, 64 boys and 66 girls) receiving antiretroviral therapy were recruited in 3 pediatric clinics. Lipodystrophy was defined based on 4 skinfold thickness measurements. Fasting lipids and glucose profile were measured in all children.
  
  
  RESULTS
  The proportion of children presenting with lipodystrophy was 24.6%. Nineteen percent of children had high-density lipoprotein values less than 1 mmol/L. Twenty-two percent and 15% of children had values greater than 2 standard deviations for age and gender for cholesterol and triglycerides, respectively. A total of 13.2% showed insulin resistance. A total of 42.7% showed at least 1 of these biologic disturbances. Prospective follow-up showed no progression at all over 2 years, except for a doubling of the number of children with insulin resistance. In multivariate analyses, ethnicity, previous severe clinical condition, duration of HIV infection, and nucleoside reverse transcriptase inhibitor treatment were significantly associated with lipodystrophy. Tanner stage V of puberty, severe clinical symptoms and protease inhibitor treatment were independently associated with the risk of metabolic disturbances.
  
  
  CONCLUSIONS
  Puberty seems to be the time when HIV-infected children taking potent antiretroviral therapy are more likely to develop lipodystrophy and metabolic complications, especially in children with a severe underlying HIV infection. Once developed, lipodystrophy and metabolic changes seem to be extremely stable with time.
authors.affiliation: INSERM Unit 690, Hôpital Robert Debré, Paris, France.
authors.forename: Marta
authors.initials: M
authors.lastname: Beregszaszi
authors.forename: Catherine
authors.initials: C
authors.lastname: Dollfus
authors.forename: Martine
authors.initials: M
authors.lastname: Levine
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.forename: Samia
authors.initials: S
authors.lastname: Deghmoun
authors.forename: Nassima
authors.initials: N
authors.lastname: Bellal
authors.forename: Muriel
authors.initials: M
authors.lastname: Houang
authors.forename: Didier
authors.initials: D
authors.lastname: Chevenne
authors.forename: Régis
authors.initials: R
authors.lastname: Hankard
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bresson
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
authors.forename: Claire
authors.initials: C
authors.lastname: Levy-Marchal
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D008060:Lipodystrophy / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors