[Lipodystrophy in HIV infected children].
The important side effect of antiretroviral treatment (ART) are metabolical disturbances and lipodystrophy. The consequences can be early atherosclerosis or ischemic heart disease. The aim of this study was to estimation of prevalence of lipodystrophy in HIV infected children on HAART risk factors and methods of its diagnosis.


METHODS
Between 2002-2005 year 52 children (aged 3-18 years) were included into study. There were 28 boys and 24 girls. An anamnesis was taken and physical examination was done every 6-12 weeks. Laboratory tests included: label of triglycerides, cholesterol with fractions, glucose. In 49 patients body composition based on Bioelectrical Impedance Analysis (BIA) and in 51 thicknesses of skin folds were measured. Patients were analyzed according to age, sex, Z score for Body Mass Index, clinical and immunological stage of HIV antiretroviral treatment (time, schemas, drugs) and its efficacy.


RESULTS
Lipodystrophy was found in 24 (46%) children (12 girls and 12 boys), mean age 9.68 years. Lipatrophy was recognized in 7, lipohipertrophy in 1 and the mixed form in 16 of cases. Children with lipodystrophy had complains much more frequently (96% vs. 64%) (p = 0.01). They had also thinner skin fold over/on the triceps (p = 0.02). Remaining skin folds were similar. Comparison of family history, age, sex, Z score for BMI, body composition based on BIA, clinical and immunological stage, efficacy of ART did not bring any significant statistical differences. All children with lipodystrophy were treated with D4T more frequently with DDI and RTV none of them received ZDV, rarely 3TC. Statistical differences were significant. In lipodystrophy group there were increased levels of triglicerydes much more frequently (79% vs. 39%) (p = 0.037). Remaining lipid abnormalities were also more frequent in that group, statistical differences were insignificant.


CONCLUSIONS
1. Lipodystrophy in observed group was very frequent. Clinical signs were recognized in 46%, hyperlipidemia in 73% of cases. Dominant was the mixed form. 2. The risk factor is treatment with D4T DDI, RTV. 3. The high risk of lipodystrophy in effective treated children changes opinion about therapeutical success and should require new therapeutical options. 4. Measurement of skin folds is useful method, but body composition based on BIA is not useful test for diagnosis of lipodystrophy.
Popielska
Jolanta
J
Medical University of Warsaw, Infectious Diseases Hospital in Warsaw, Department of Childrens' Infectious Diseases, Poland. jolantapopielska@wp.pl
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000453:epidemiology; D007223:Infant; D008060:Lipodystrophy / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D012307:Risk Factors