title: Prevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy.
abstract: BACKGROUND
  Most pediatric lipodystrophy data come from high-income/middle-income countries, but most HIV-infected children live in sub-Saharan Africa, where lipodystrophy studies have predominantly investigated stavudine-based regimens.
  
  
  METHODS
  Three years after antiretroviral therapy (ART) initiation, body circumferences and skinfold thicknesses were measured (n = 590), and fasted lipid profile assayed (n = 325), in children from 2 ARROW trial centres in Uganda/Zimbabwe. Analyses compared randomization to long-term versus short-term versus no zidovudine from ART initiation [unadjusted; latter 2 groups receiving abacavir+lamivudine+non-nucleoside-reverse-transciptase-inhibitor (nNRTI) long-term], and nonrandomized (confounder-adjusted) receipt of nevirapine versus efavirenz.
  
  
  RESULTS
  Body circumferences and skinfold thicknesses were similar regardless of zidovudine exposure (P > 0.1), except for subscapular and supra-iliac skinfolds-for-age which were greater with long-term zidovudine (0.006 < P < 0.047). Circumferences/skinfolds were also similar with efavirenz and nevirapine (adjusted P > 0.09; 0.02 < P < 0.03 for waist/waist-hip-ratio). Total and high-density lipoprotein (HDL)-cholesterol, HDL/triglyceride-ratio (P < 0.0001) and triglycerides (P = 0.01) were lower with long-term zidovudine. Low-density lipoprotein (LDL)-cholesterol was higher with efavirenz than nevirapine (P < 0.001). Most lipids remained within normal ranges (75% cholesterol, 85% LDL and 100% triglycerides) but more on long-term zidovudine (3 NRTI) had abnormal HDL-cholesterol (88% vs. 40% short/no-zidovudine, P < 0.0001). Only 8/579(1.4%) children had clinical fat wasting (5 grade 1; 3 grade 2); 2(0.3%) had grade 1 fat accumulation.
  
  
  CONCLUSIONS
  Long-term zidovudine-based ART is associated with similar body circumferences and skinfold thicknesses to abacavir-based ART, with low rates of lipid abnormalities and clinical lipodystrophy, providing reassurance where national programs now recommend long-term zidovudine. Efavirenz and nevirapine were also similar; however, the higher LDL observed with efavirenz and lower HDL observed with zidovudine suggests that zidovudine+lamivudine+efavirenz should be investigated in future.
authors: *University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; †Joint Clinical Research Centre; ‡Makerere University, College of Health Sciences, Kampala, Uganda; §Medical Research Council Clinical Trials Unit; ¶ Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, United Kingdom; ‖Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda; and **Pediatric Infectious Diseases Clinic/Baylor - Uganda, Mulago Hospital, Kampala, Uganda.
authors: Mutsawashe
authors: M
authors: Bwakura-Dangarembizi
authors: Victor
authors: V
authors: Musiime
authors: Alexander J
authors: AJ
authors: Szubert
authors: Andrew J
authors: AJ
authors: Prendergast
authors: Zvenyika A
authors: ZA
authors: Gomo
authors: Margaret J
authors: MJ
authors: Thomason
authors: Cuthbert
authors: C
authors: Musarurwa
authors: Peter
authors: P
authors: Mugyenyi
authors: Patricia
authors: P
authors: Nahirya
authors: Adeodata
authors: A
authors: Kekitiinwa
authors: Diana M
authors: DM
authors: Gibb
authors: Ann S
authors: AS
authors: Walker
authors: Kusum
authors: K
authors: Nathoo
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D050218:Body Fat Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008055:Lipids / Q000097:blood; D008060:Lipodystrophy / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D008055:Lipids