Prospective follow up of children with lipodystrophy

HIV Treat Bull - Vol. 7, No. 5, May 2006

There are limited prospective data on lipodystrophy in HIV positive children, particularly with regard to the changes that take place during puberty, and the prognostic value and clinical significance of the different types of fat redistribution and lipid/glucose abnormalities [1].

Cross-sectional studies have estimated prevalence of lypodystrophy of 2-33% in HIV positive children in Europe.

A poster from Alessandra Viganò and coworkers from the Department of Paediatrics in Milan and the Institute of Child Health in London presented findings from a study of 55 HIV positive children and adolescents (32 female, 23 male) with lipodystrophy from 12 Italian paediatric centres. The children were identified in a cross-sectional study in 2003 and were followed up in June to November 2004. The follow up data include clinical characteristics, laboratory assessments, current antiretroviral therapy, and management of lipodystrophy symptoms.

The authors found the median age of the children in the study, at the time of follow-up data collection, was 14.1 years (range 8.2 to 22.0 years) at the follow-up data collection. They described the children’s current HIV status as 15 (27%) with no/mild symptoms; 22 (40%) with moderate symptoms, and 18 (33%) with severe symptoms.

Out of the 32 children with recent HIV RNA measurements, 18 (56%) were undetectable (14 <50 and 4 <500 copies/mL) and 14 detectable (median 5,865 copies/mL).

All children were receiving HAART, except for one child who had stopped all antiretrovirals at the age of 15 years. For 22 (40%) children one of the reasons for prior antiretroviral modifications had been body composition changes or dyslipidemia.

Clinical signs of fat redistribution were present in 49 (89%) children: 9 had central lipohypertrophy only, 13 peripheral lipoatrophy only, and the remaining 27 had a combination of both (combined sub-type).

Nine children (median age 14.5 years, 3 male) had severe lipoatrophy (median 4 body sites, median body mass index 17.8) and a further 11 had severe central lipohypertrophy (median age 12.3 years, median body mass index 21.6, median waist:hip ratio 0.92 girls, 0.98 boys). Hypertriglyceridemia was present in 19 (35%) children and hypercholesterolemia in 14 (25%) (8 children had both concurrently).

Ten (18%) children had received drug treatment for lipodystrophy (9 with recombitant human growth hormone, 1 phenofibrate); of these 8 were receiving other interventions (3 dietary, 5 physical activity and 1 surgical: liposuction for buffalo hump).

They concluded their findings: “Lipodystrophy syndrome arising in childhood in HIV infected children receiving ARVs does not appear to resolve in the majority of cases.” An that only “13% of children with body fat redistribution had no clinical signs of this by their follow up visit (median 4 years later)” They added: “Nearly a quarter of children showed some sign of progression with regard to fat distribution; however this was mainly due to progression of the combined fat loss and fat accumulation, rather than due to increasing severity of fat loss or fat gain.”

In a second poster from the same group in Milan, in which they followed 24 children and adolescents switched from d4T to TDF, found that their lipoatrohy did not change or worsen over this period of time [2].

References

1. Viganò A, Giacomet V, Martelli L et al. Prospective follow-up of HIV-infected children and young people with lipodystrophy. 13th CROI, Denver, 2006. Abstract 692.
2. Viganò A, Brambilla P, Cafarelli L et al. Improvement in lipoatrophy associated with highly active antiretroviral therapy in HIV-infected children and adolescents switched from stavudine to tenofovir. 13th CROI, Denver, 2006. Abstract 693.

2008-03-10
IB060705-22

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