High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy: a cross-sectional study

Abstract

BackgroundDespite changes in WHO guidelines, stavudine is still used extensively for treatment of pediatric HIV in the developing world. Lipoatrophy in sub-Saharan African children can be stigmatizing and have far-reaching consequences. The severity and extent of lipoatrophy in pre-pubertal children living in sub-Saharan Africa is unknown.MethodsIn this cross-sectional study, children who were 3-12 years old, on antiretroviral therapy and pre-pubertal were recruited from a Family HIV Clinic in South Africa. Lipoatrophy was identified and graded by consensus between two HIV pediatricians using a standardized grading scale. A professional dietician performed formal dietary assessment and anthropometric measurements of trunk and limb fat. Previous antiretroviral exposures were recorded. In a Dual-Energy X-ray Absorbtiometry (DXA) substudy body composition was determined in 42 participants.ResultsAmong 100 recruits, the prevalence of visually obvious lipoatrophy was 36% (95% CI: 27%–45%). Anthropometry and DXA measurements corroborated the clinical diagnosis of lipoatrophy: Both confirmed significant, substantial extremity fat loss in children with visually obvious lipoatrophy, when adjusted for age and sex. Adjusted odds ratio for developing lipoatrophy was 1.9 (95% CI: 1.3 - 2.9) for each additional year of accumulated exposure to standard dose stavudine. Cumulative time on standard dose stavudine was significantly associated with reductions in biceps and triceps skin-fold thickness (p=0.008).ConclusionsThe prevalence of visually obvious lipoatrophy in pre-pubertal South African children on antiretroviral therapy is high. The amount of stavudine that children are exposed to needs review. Resources are needed to enable low-and-middle-income countries to provide suitable pediatric-formulated alternatives to stavudine-based pediatric regimens. The standard stavudine dose for children may need to be reduced. Diagnosis of lipoatrophy at an early stage is important to allow timeous antiretroviral switching to arrest progression and avoid stigmatization. Diagnosis using visual grading requires training and experience, and DXA and comprehensive anthropometry are not commonly available. A simple objective screening tool is needed to identify early lipoatrophy in resource-limited settings where specialized skills and equipment are not available.

Lipodystrophy syndrome among HIV infected children on highly active antiretroviral therapy in northern India

“…However on multivariate analysis significant association was observed only with increasing duration of treatment. This was similar to what was reported by Aurpibul et al (22) , Kinabo et al (33) , Piloya et al (34) , Innes et al (35) and Griensven et al whereas Pujari et al (8) did not find any association with age and duration of therapy.…”

“…In our experience there was significant difference between the lipodystrophy group and non lipodystrophy group with regard to hypertriglyceridaemia, hypercholestrolaemia and high LDL levels and is consistent with that reported by Pujari et al (8) , Musiime et al (32) and Aurpibul et al (22) . Piyola et al (35) did not observe any significant difference between the two groups with regard to presence of dyslipidaemia. Dyslipidaemia was also observed in non lipodystrophic group which is similar to findings of Piyola et al (34) and suggest that lipid metabolism abnormalities could precede clinical lipodystrophy.…”

“…Regional analysis of body fat composition by various techniques like DEXA (31,35) , bioelectric impedence (25) and measurement of skin fold thickness (32) are more sensitive methods. Due to limitation of resources, subjective method was used to assess fat redistribution.…”

“…It has been proposed that antiretroviral drugs such as protease inhibitors (PI) and/ or nucleoside analogues (stavudine) could contribute to the development of such clinical and metabolic abnormalities (2,6,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(28)(29)(30)(31)(32)(33)(34)(35) . Various risk factors have been found to be associated with the development of lipodystrophy like older age and increasing duration of treatment (22,33,34,35) . Studies have reported complications associated with lipodystrophy syndrome viz cardiovascular complications (5) and diabetes mellitus type 2 later in life.…”

Aterosclerose Precoce na População Pediátrica Infetada pelo VIH: Revisão da Literatura e Abordagem Clínica

“…É frequentemente um efeito secundário dos inibidores da protease, embora possa existir na ausência de terapêutica antirretrovírica. [25][26][27][28][29][30][31][32][33][34] Num subgrupo minoritário de doentes, a lipohipertrofia pode coexistir com a lipoatrofia, existindo um padrão misto Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com de apresentação. A dislipidémia, por sua vez, está presente em 40% a 75% das crianças mais velhas e adolescentes com antecedentes de terapêutica antirretrovírica prolongada.…”