title: Biceps skin-fold thickness may detect and predict early lipoatrophy in HIV-infected children.
abstract: BACKGROUND
  The prevalence of potentially stigmatizing lipoatrophy in children receiving antiretroviral therapy in Southern Africa is high, affecting around a third of children. Early diagnosis of lipoatrophy is essential for effective intervention to arrest progression.
  
  
  METHODS
  Prepubertal children receiving antiretroviral therapy were recruited from a hospital-based family HIV clinic in Cape Town and followed up prospectively. Lipoatrophy was identified and graded by consensus between 2 HIV pediatricians. A dietician performed anthropometric measurements of trunk and limb fat. Anthropometric measurements in children with and without lipoatrophy were compared using multivariable linear regression adjusting for age and gender. The most discerning anthropometric indicators of lipoatrophy underwent receiver operating characteristic curve analysis. The precision of anthropometric measurements performed by an inexperienced healthcare worker was compared with that of a research dietician.
  
  
  RESULTS
  Of 100 recruits, 36 had lipoatrophy at baseline and a further 9 developed lipoatrophy by 15-month follow-up. Annual incidence of lipoatrophy was 12% (confidence interval [CI]: 5-20%) per person-year of follow-up. A biceps skin-fold thickness <5 mm at baseline had a sensitivity of 89% (CI: 67-100%) and a specificity of 60% (CI: 46-75%) for predicting development of lipoatrophy by 15-month follow-up. Negative and positive predictive values were 97% (CI: 91-100%) and 32% (CI: 14-50%).
  
  
  CONCLUSIONS
  Biceps skin-fold thickness <5 mm in prepubertal children exposed to thymidine analogue-based antiretroviral therapy may be a useful screening tool to identify children who are likely to develop lipoatrophy. The variation in precision of measurements performed by an inexperienced healthcare worker only marginally impacted performance.
authors.affiliation: Children's Infectious Diseases Clinical Research Unit, Tygerberg Children's Hospital, and Department of Paediatrics, Stellenbosch University, Cape Town, South Africa. innes@sun.ac.za
authors.forename: Steve
authors.initials: S
authors.lastname: Innes
authors.forename: Eva
authors.initials: E
authors.lastname: Schulte-Kemna
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.forename: Ekkehard Werner
authors.initials: EW
authors.lastname: Zöllner
authors.forename: Richard
authors.initials: R
authors.lastname: Haubrich
authors.forename: Hartwig
authors.initials: H
authors.lastname: Klinker
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Sun
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.forename: Clair
authors.initials: C
authors.lastname: Edson
authors.forename: Margaret
authors.initials: M
authors.lastname: van Niekerk
authors.forename: Emily Ryan
authors.initials: ER
authors.lastname: Innes
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Sara H
authors.initials: SH
authors.lastname: Browne
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology*; D000353:Africa, Southern; D000886:Anthropometry / Q000379:methods; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001132:Arm / Q000033:anatomy & histology; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012867:Skin / Q000033:anatomy & histology*
chemical_list: D019380:Anti-HIV Agents