Longitudinal evaluation and risk factors of lipodystrophy and associated metabolic changes in HIV-infected children.
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.
Beregszaszi
Marta
M
INSERM Unit 690, Hôpital Robert Debré, Paris, France.
Dollfus
Catherine
C
Levine
Martine
M
Faye
Albert
A
Deghmoun
Samia
S
Bellal
Nassima
N
Houang
Muriel
M
Chevenne
Didier
D
Hankard
Régis
R
Bresson
Jean-Louis
JL
Blanche
Stéphane
S
Levy-Marchal
Claire
C
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