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Bockhorst, James; Ksseiry, Iyad; Toye, Maripat; Chipkin, Stuart R.; Stechenberg, Barbara W.; Fisher, Donna; Allen, Holley

doi:10.1097/00006454-200305000-00017

Cited by 8 publications

(4 citation statements)

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“…The prevalence of fat abnormality here was substantially higher than the 18-33% reported in other paediatric studies[8, 10-12, 31-33], reflecting variations in LS definitions and methodology, and underlying population differences. However, restricting the definition to moderate and severe cases resulted in a prevalence of 19%.…”

Section: Discussioncontrasting

confidence: 75%

Body Fat Abnormality in HIV-Infected Children and Adolescents Living in Europe

Alam

Cortina‐Borja

Goetghebuer

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Discussioncontrasting

confidence: 75%

Body Fat Abnormality in HIV-Infected Children and Adolescents Living in Europe

Alam

Cortina‐Borja

Goetghebuer

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Insulin resistance is characterized by reduced insulin stimulation of glucose use by adipose tissue and muscles resulting in increased pancreatic insulin production, and is associated with obesity, dyslipidaemia, hypertension and type 2 diabetes in children [ 220 ]. Both PIs and NRTIs are associated with insulin resistance through inhibition of GLUT-4 transporters in myocytes and adipocytes, causing decreased uptake of glucose by these tissues [ 221 , 222 ]. HAART-associated body composition changes such as central obesity, resulting in fat deposition in muscle cells, may also contribute to insulin resistance [ 223 ], but data are inconclusive [ 224 , 225 ].…”

Section: Resultsmentioning

confidence: 99%

The physical and psychological effects of HIV infection and its treatment on perinatally HIV‐infected children

Vreeman

Scanlon

McHenry

et al. 2015

Journal of the International AIDS Society

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IntroductionAs highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and psychological health due to HIV infection and its lifelong treatment.MethodsWe conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV (PHIV+) infection and its treatment in the era of HAART, including major chronic comorbidities.Results and discussionPerinatally infected children face concerning levels of treatment failure and drug resistance, which may hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV+ infection and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected children may face psychological challenges, including higher rates of mental health and behavioural disorders. Existing studies have significant methodological limitations, including small sample sizes, inappropriate control groups and heterogeneous definitions, to name a few.ConclusionsSuccess in treating perinatally HIV-infected children and better understanding of the physical and psychological implications of lifelong HIV infection require that we address a new set of challenges for children. A better understanding of these challenges will guide care providers, researchers and policymakers towards more effective HIV care management for perinatally infected children and their transition to adulthood.

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“…Studies have shown differing results on the association of glucose homeostasis with PIs and LD syndrome [48,49]. Impaired glucose homeostasis has been reported among 8–35% of HIV-infected children [31]. However, no differences were detected in fasting serum insulin, proinsulin, C-peptide, insulin:glucose ratio or Homeostasis Model of Assessment (HOMA-IR) between PI-treated and PI-naïve children [48,50–52].…”

Section: Lipodystrophy Syndromementioning

confidence: 99%

Metabolic complications and treatment of perinatally HIV‐infected children and adolescents

Barlow‐Mosha

Eckard

McComsey

et al. 2013

Journal of the International AIDS Society

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The benefits of long-term antiretroviral therapy (ART) are recognized all over the world with infected children maturing into adults and HIV infection becoming a chronic illness. However, the improved survival is associated with serious metabolic complications, including lipodystrophy (LD), dyslipidemia, insulin resistance, lactic acidosis and bone loss. In addition, the dyslipidemia mainly seen with protease inhibitors may increase the risk of cardiovascular disease in adulthood and potentially in children as they mature into adults. Nucleoside reverse transcriptase inhibitors, particularly stavudine, zidovudine and didanosine are linked to development of LD and lactic acidosis. Perinatally infected children initiate ART early in life; they require lifelong therapy with multiple drug regimens leading to varying toxicities, all potentially impacting their quality of life. LD has a significant impact on the mental health of older children and adolescents leading to poor self-image, depression and subsequent poor adherence to therapy. Reduced bone mineral density (BMD) is reported in both adults and children on ART with the potential for children to develop more serious bone complications than adults due to their rapid growth spurts and puberty. The role of vitamin D in HIV-associated osteopenia and osteoporosis is not clear and needs further study. Most resource-limited settings are unable to monitor lipid profiles or BMD, exposing infected children and adolescents to on-going toxicities with unclear long-term consequences. Improved interventions are urgently needed to prevent and manage these metabolic complications. Longitudinal cohort studies in this area should remain a priority, particularly in resource-limited settings where the majority of infected children reside.

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Cited by 8 publications

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Body Fat Abnormality in HIV-Infected Children and Adolescents Living in Europe

Body Fat Abnormality in HIV-Infected Children and Adolescents Living in Europe

The physical and psychological effects of HIV infection and its treatment on perinatally HIV‐infected children

Metabolic complications and treatment of perinatally HIV‐infected children and adolescents

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