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Longitudinal evaluation and risk factors of lipodystrophy and associated metabolic changes in HIV-infected children
Marta Beregszaszi1, Catherine Dollfus, Martine Levine
1INSERM Unit 690, Hôpital Robert Debré, Paris, France.
Insights
Lipodystrophy and metabolic issues in HIV-infected children on antiretroviral therapy remain stable after initial development. Puberty is a critical period for the onset of these conditions, particularly in those with severe HIV infection.
Area of Science:
- Pediatric infectious diseases
- Metabolic disorders
- HIV/AIDS management
Background:
- Lipodystrophy and metabolic disturbances are potential side effects of antiretroviral therapy in children with HIV.
- Understanding the progression and risk factors is crucial for optimizing treatment and patient outcomes.
Purpose of the Study:
- To evaluate the 2-year progression rate of lipodystrophy and associated metabolic disturbances in children with HIV.
- To identify risk factors contributing to the development of lipodystrophy and metabolic complications.
Main Methods:
- A multicenter, 2-year prospective study involving 130 children (median age 10 years) on antiretroviral therapy.
- Standardized evaluations included skinfold thickness measurements for lipodystrophy, and fasting lipid and glucose profiles for metabolic assessment.
Main Results:
- 24.6% of children presented with lipodystrophy; 42.7% had at least one metabolic disturbance (dyslipidemia, insulin resistance).
- No significant progression of lipodystrophy or metabolic changes was observed over 2 years, except for a doubling in insulin resistance.
- Risk factors for lipodystrophy included ethnicity, severe clinical condition, HIV duration, and nucleoside reverse transcriptase inhibitor use. Puberty, severe symptoms, and protease inhibitor use were linked to metabolic disturbances.
Conclusions:
- Puberty is a key period for the onset of lipodystrophy and metabolic complications in HIV-infected children on antiretroviral therapy, especially those with severe HIV.
- Once established, lipodystrophy and associated metabolic changes appear to be stable over time in this pediatric population.
Objective:
To assess the rate of progression of lipodystrophy and the associated metabolic disturbances over a 2-year period in children and to assess risk factors associated with lipodystrophy and metabolic disturbances.
Design:
Multicenter 2-year prospective study with a standardized evaluation.
Methods:
One hundred thirty children (median age = 10 years, 64 boys and 66 girls) receiving antiretroviral therapy were recruited in 3 pediatric clinics. Lipodystrophy was defined based on 4 skinfold thickness measurements. Fasting lipids and glucose profile were measured in all children.
Results:
The proportion of children presenting with lipodystrophy was 24.6%. Nineteen percent of children had high-density lipoprotein values less than 1 mmol/L. Twenty-two percent and 15% of children had values greater than 2 standard deviations for age and gender for cholesterol and triglycerides, respectively. A total of 13.2% showed insulin resistance. A total of 42.7% showed at least 1 of these biologic disturbances. Prospective follow-up showed no progression at all over 2 years, except for a doubling of the number of children with insulin resistance. In multivariate analyses, ethnicity, previous severe clinical condition, duration of HIV infection, and nucleoside reverse transcriptase inhibitor treatment were significantly associated with lipodystrophy. Tanner stage V of puberty, severe clinical symptoms and protease inhibitor treatment were independently associated with the risk of metabolic disturbances.
Conclusions:
Puberty seems to be the time when HIV-infected children taking potent antiretroviral therapy are more likely to develop lipodystrophy and metabolic complications, especially in children with a severe underlying HIV infection. Once developed, lipodystrophy and metabolic changes seem to be extremely stable with time.
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