Lipodystrophic syndrome in children and adolescents infected with the human immunodeficiency virus

Abstract

The introduction of highly active antiretroviral therapy (HAART) for the treatment of acquired immunodeficiency syndrome (AIDS) has resulted in greater survival of patients infected with the human immunodeficiency virus (HIV). However, the use of these drugs has been associated with lipodystrophic syndrome (LS), which is characterized by metabolic alterations (dyslipidemia, insulin resistance, diabetes, and lactic acidosis) and abnormal corporal fat distribution. Clinically, LS may manifest as three different forms: lipohipertrophy (accumulation of fat in the central part of the body), lipoatrophy (loss of fat in the extremities, face and buttocks) and mixed (lipohipertrophy + lipoatrophy). Although its physiopathology has not been elucidated, some mechanisms have been described, including leptin and adiponectin deficiency, mitochondrial dysfunction and use of antiretroviral drugs. The type, dose and duration of the antiretroviral treatment, as well as age and puberty are the main risk factors. LS is also associated with increased incidence of cardiovascular illnesses, atherosclerosis and diabetes mellitus. Treatment includes physical activity, cautious restriction of caloric intake, changes in antiretroviral therapy, and use of insulin-sensitizing and lipid-lowering agents. Follow up must be periodic, consisting of measurement of body fat distribution, evaluation of the lipid profile and insulin resistance.

Epidemiological aspects of acquired immunodeficiency syndrome in older Brazilians: a comparative approach

“…1 Although in the early years the epidemic was mainly disseminated among young gay men, there has been a progressive shift in the epidemic pattern, with cases among women 2 and children, 3 representing an important segment of the AIDS patients in recent years. Despite a reduction in the total number of new cases in other age groups, 4 the older population has experienced an increase in notifications.…”

Satisfação corporal e características de lipodistrofia em crianças e adolescentes com HIV/AIDS em uso de terapia antirretroviral de alta potência

“…The advent of highly active antiretroviral therapy (HAART) changed the natural history of HIV infection, decreasing mortality and slowing disease progression in people living with the disease (2) . Nevertheless, several negative aspects of this therapy have been observed, including lipodystrophy, which is characterized by changes in body fat distribution (lipoatrophy and lipohypertrophy) (3) .…”

Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada

“…Few studies have dealt with prevention and treatment of redistribution of body fat and lipodystrophy syndrome in the pediatric age group. 9 Bearing in mind the high frequency of dyslipidemia and lipodystrophy found in this study population, indicating a relationship with the antiretroviral regimen employed, it is pertinent to emphasize the importance of multidisciplinary care for children and adolescents with AIDS, including wide-ranging nutritional education and lifestyle changes, in order to minimize the risk of the development of future complications, such as cardiovascular diseases.…”

“…In order to explain this finding, we developed some hypotheses: the low age of the study population; limitations due to the study methodology (cross-sectional), which did not allow for evaluation of the development of the parameters studied over time; and limitations of the clinical examination method used to assess body fat redistribution, without supplementary tests such as DXA. 9 The importance of early identification of lipodystrophy syndrome lies in the fact that it is related to future development of cardiovascular events. 26,30 The redistribution of body fat may also prejudice compliance with treatment, causing depression and low self-esteem, especially among adolescents.…”

“…Clinical diagnosis of lipodystrophy, widely used in practice, underestimates the redistribution of body fat when compared with specific tests for the same purpose, such as dual-energy X-rays (DXA). 9 There have been few studies evaluating the relationship between redistribution of body fat assessed clinically Prevention. 10 Children and adolescents were excluded if they were on corticosteroids, if they had suffered severe disease or been admitted to hospital during the 3 months prior to starting the study or if they had other chronic diseases such as heart disease, kidney disease, neuropathy, rheumatic diseases, lung disease or liver disease.…”