Metabolic disorders more likely at puberty for children on HIV therapy

Metabolic complications caused by antiretroviral therapy, such as lipid elevations and insulin resistance, are more likely to emerge with the onset of puberty in children, say French researchers in a report to the October 1^st issue of the Journal of Acquired Immune Deficiency Syndromes. Screening for body fat and metabolic changes should be stepped up at puberty, they recommend.

The study recruited 130 children from Paris hospitals from the beginning of 2000 with the aim of tracking the progression of lipodystrophy in children and identify risk factors. Eighty-nine were available for follow-up two years later.

Participants had a median age of ten years at baseline, 64 were boys and 66 were girls. African and Caucasian children were almost equally represented, and 89% had been infected through mother-to-child transmission. Most had experienced advanced HIV disease, with a median nadir CD4 percentage of 15.5%, and 96% had received some form of HIV treatment by the time they entered the study. Most treatment regimens contained nucleoside analogues (89%) and a majority contained a protease inhibitor (52%). Dual or triple nucleoside regimens were more common than triple NNRTI regimens in this group of patients. The median duration of treatment was 36 months of exposure to NRTIs and 24 months of exposure to PIs.

The study found that just under one quarter of children had some evidence of lipodystrophy at baseline (24.6%), and this proportion did not grow significantly over two years of follow-up. Lipodystrophy was most strongly associated with duration of NRTI exposure and ethnicity, with African children much less likely to suffer fat changes (OR 0.14, p=0.003).

Metabolic disturbances affected 46% of children at baseline, and this proportion fell slightly in the follow-up sample of 89 patients. However multivariate analysis showed that the risk of metabolic disturbance (dyslipidemia and insulin resistance) rose for children who had reached the most advanced stage of puberty, and the proportion of children with insulin resistance almost doubled over two years of follow-up. African children were at lower risk of low HDL cholesterol.

“Puberty seems to be the time when children are most likely to develop lipodystrophy and metabolic complications”, assert the investigators, although the findings of the study provide no evidence in bivariate or multivariate analysis that stage of puberty affects the risk of lipodystrophy.