Over a quarter of HIV-positive children on treatment have lipodystrophy in European study

Michael Carter
Published: 18 June 2004

Over a quarter of HIV-positive children and adolescents had body fat redistribution and over a third had elevated blood lipids according to a European study published in the July 2nd edition of AIDS. An AIDS diagnosis, female sex, and the use of a protease inhibitor or d4T were all independently associated with body fat redistribution and abnormal blood fats in the children and adolescents.

Although lipodystrophy has been extensively studied and described in adults, there have been few studies of the syndrome in children and adolescents. Assessment of body shape change in children can be complicated by normal growth, and although abnormal lipids have been reported in HIV-positive children, the data are sparse.

Accordingly, investigators from the European Paediatric Lipodystrophy Group conducted a cross-sectional observational study involving 477 HIV-positive children and adolescents aged between three and 18 years to obtain an estimate of the prevalence of body fat redistribution and elevated blood lipids, and the associated risk factors. The children were recruited over a three-month period from 30 specialist paediatric HIV clinics across Europe. 92% were receiving antiretroviral treatment at the time of analysis.

The investigators developed a uniform check list of signs of body fat redistribution including fat wasting and fat accumulation. Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and fasting glucose were also measured for 280 of the children attending 18 of the clinics.

In total,124 (26%) of the children and adolescents showed signs of body fat redistribution. Of these 46 (37%) had a combination of both fat loss and fat gain, 42 (34%) had fat accumulation, and 36 (29%) had fat loss. Risk factors for body fat redistribution included female sex (p = 0.047), an AIDS diagnosis (p < 0.001), older age (p = 0.018), use of HAART (p = 0.002), and longer duration of antiretroviral use (p = 0.019). In further analysis, the investigators also found that the use of any protease inhibitor was associated with the risk of fat redistribution, as was the use of the NRTI d4T.

Analysis of the metabolic abnormalities was limited to a subgroup of 280 children who had their blood lipids monitored. Elevated cholesterol was seen in 27% of these, and elevated triglycerides in 21%. The overall prevalence of any elevated blood lipid was 38%.

Elevated cholesterol was more common in girls than boys (32% versus 20%, p = 0.014), and the use of a protease inhibitor was significantly associated with elevated cholesterol (37% versus 9%, p = 0 .007). Risk factors for elevated triglycerides included an AIDS diagnosis (33% versus 22%, p = 0.012), and the use of HAART (25% versus 11%, p = 0.006). In further analysis, the investigators established that elevated triglycerides were associated with the use of a protease inhibitor (p = 0.004), particularly ritonavir (p < 0.002). The investigators also found a higher prevalence of abnormally high triglycerides in children and adolescents who had ever taken d4T (28% versus 9%, p = 0.006).

”Our results demonstrate that lipodystrophy among HIV-infected children in Europe is already a significant issue, despite the fact that HAART has only been widely used for the past five years”, comment the investigators. They also warn “the problem may worsen with time” as they found an association between lipodystrophy and increasing age and longer duration of HAART.

The finding that over a third of HIV-positive young people had abnormally high blood lipids also caused the investigators concern. “The long-term impact on future risk of atherosclerotic disease in infected children is uncertain and further research is needed”, they comment.

The investigators acknowledge the limitations and a cross-sectional study and conclude “prospective studies to investigate lipodystrophy in HIV-infected children are urgently needed, in particular to help elucidate the prognostic value of fat redistribution signs and those relating to lipid and glucose metabolism, and to inform approaches for optimum clinical management.”

Further information on this website

Body fat and metabolic changes whilst on treatment - menu

HIV and children - booklet in the information for HIV-positive people series (pdf)

Reference

European Paediatric Lipodystrophy Group. Antiretroviral therapy, fat redistribution and hyperlipidaemia in HIV-infected children in Europe. AIDS 18: 1443-1451, 2004.

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