Lypodystrophy in HIV-Infected Children is Associated with High Viral Load and Low CD4+-Lymphocyte Count and CD4+-Lymphocyte Percentage at Baseline and Use of Protease Inhibitors and Stavudne
Purpose of the Study. Maldistribution of body fat often associated with abnormalities in lipid and insulin metabolism (“lypodystrophy”) has been reported in human immunodeficiency virus (HIV)-infected adults. This study was initiated to determine whether similar abnormalities occur in children with HIV.
Methods. Twenty-eight prepubertal HIV-infected children were studied. Total and regional body fat mass was measured by dual energy x-ray absorptiometry (DEXA). Lypodystrophy was defined by both a decrease in arm and leg fat (extremity lypoatrophy) and an increase in truncal fat as measured by repeat DEXA. Baseline and follow-up characteristics of children with an without lypodystrophy were compared and factors associated with lypodystrophy were identified using odds ratios and appropriate statistical analyses.
Results. Eight of the twenty-eight children (29%) experienced lypodystrophy as defined. Children with lypodystrophy had significantly higher levels of HIV RNA, and lower CD4+ T-cell counts. Lypodystrophy was associated with the use of protease inhibitors and stavudine (d4T).
Conclusions. In this longitudinal observational study, 29% of children experienced morphologically defined lypodystrophy. This finding strongly suggests that children are also likely at risk for elevation in athrogenic lipid levels and insulin resistance as previously described in adults with HIV and lypodystrophy.
Reviewer’s Comments. Lypodystrophy is one of several emerging complications seen in HIV-infected children. These complications are likely related to the complex interplay of intrinsic host lipid metabolism, the presence of chronic HIV infection, and the specific drugs used to treat HIV. Lypodystrophy may be associated with significant cosmetic alterations in body habitus and consequently social and emotional disturbances. The long-term impact of the changes associated with lypodystrophy are yet to be defined in children but are likely to involve cardiovascular complications. The improved duration and quality of life of HIV patients is associated with significant long-term metabolic complications.
- Copyright © 2002 by the American Academy of Pediatrics