Lipodystrophy and metabolic complications of highly active antiretroviral therapy.
OBJECTIVE
To assess the metabolic drug toxicities of first-line, World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens, to estimate the prevalence of body fat redistribution and to identify associated risk factors.


METHODS
Cross-sectional observational study. During 3 month period, 52 HIV infected children (25 on HAART; 27 not on HAART) were assessed. Their sociodemographic, clinical, and immunological data was recorded. Children were examined or the signs of fat redistribution (peripheral lipoatrophy and central lipohypertrophy). Liver function tests, fasting blood sugar, lipid profile, serum amylase, serum lactate, blood pH and bicarbonate levels were done in all patients.


RESULTS
Twenty-two patients were on stavudine and three on zidovudine based HAART. None of the patients ever received any protease inhibitor. There were no cases of clinical or immunological failure. Children on HAART had significantly lower weight for age and body mass index but the mean height for age was similar between study groups. Only two cases of peripheral lipoatrophy were observed. Hypercholesterolemia was observed in four children on HAART but none without therapy. Hypertriglyceridemia was observed in three children on HAART and seven without therapy. Four cases of asymptomatic mild hyperlactatemia were observed. No case of any hyperglycemia or liver impairment was observed.


CONCLUSIONS
Metabolic abnormalities and lipodystrophy are emerging complications of HAART in Indian children and needs very close follow up. Future studies with larger sample size and longitudinal model are recommended.
Parakh
Ankit
A
Department of Pediatrics, Maulana Azad Medical College and Associated Hospitals, New Delhi, India. ankitparakh102@rediffmail.com
Dubey
Anand Prakash
AP
Kumar
Ajay
A
Maheshwari
Anshu
A
D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors