Related Experiment Video
Updated: May 15, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Biceps skin-fold thickness may detect and predict early lipoatrophy in HIV-infected children
Steve Innes1, Eva Schulte-Kemna, Mark F Cotton
1Children's Infectious Diseases Clinical Research Unit, Tygerberg Children's Hospital, and Department of Paediatrics, Stellenbosch University, Cape Town, South Africa. innes@sun.ac.za
Insights
A simple skin fold test can help detect lipoatrophy in children on antiretroviral therapy. Early identification of this condition is crucial for timely intervention and better health outcomes.
Area of Science:
- Pediatrics
- HIV/AIDS Treatment
- Public Health
Background:
- Lipoatrophy affects approximately one-third of children on antiretroviral therapy in Southern Africa.
- Early diagnosis of lipoatrophy is critical for effective intervention to prevent disease progression.
Purpose of the Study:
- To identify anthropometric indicators for early lipoatrophy detection in children.
- To assess the utility of biceps skin-fold thickness as a screening tool for lipoatrophy.
Main Methods:
- Prospective study of 100 prepubertal children receiving antiretroviral therapy in Cape Town.
- Anthropometric measurements (trunk and limb fat) compared between children with and without lipoatrophy.
- Receiver operating characteristic (ROC) curve analysis to determine the most accurate indicators.
Main Results:
- 36% of children had lipoatrophy at baseline; 9% developed it by 15 months.
- Annual incidence of lipoatrophy was 12% per person-year.
- Biceps skin-fold thickness <5 mm predicted lipoatrophy development with 89% sensitivity and 60% specificity.
Conclusions:
- Biceps skin-fold thickness <5 mm may serve as a valuable screening tool for identifying children at risk of lipoatrophy.
- Measurement precision by inexperienced healthcare workers had minimal impact on the tool's performance.
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%).
Conclusion:
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.
