Recovery From Lipodystrophy in HIV–infected Children After Substitution of Stavudine With Zidovudine in a Non-nucleoside Reverse Transcriptase Inhibitor–based Antiretroviral Therapy

Aurpibul, Linda; Puthanakit, Thanyawee; Taejaroenkul, Sineenart; Sirisanthana, Thira; Sirisanthana, Virat

doi:10.1097/inf.0b013e31823f0e11

Cited by 38 publications

(76 citation statements)

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“…Contrary to our study, Aurpibul in Thailand had noticed that lipodystrophy was more common in girls than boys, 61% and 39% of cases respectively [5]. Actually, there are seemed to be gender-based physiological differences in the occurrence of lipodystrophy.…”

Section: Discussioncontrasting

confidence: 52%

“…In all these three researches mentioned above, study design included adolescents aged 18 years in whom the risk of occurrence of lipodystrophy is higher than that of under 15 years [5] [10] [11]. Other diagnostic methods are more accurate and should be used whenever possible; skin fold measurement or muscles Dexa-scan and body fat assessment [18] [19].…”

Section: Discussionmentioning

confidence: 99%

“…A prevalence rate of 20% to 80% has been reported [5] [6]. Several authors have shown that lipid disorders due to the long term antiretroviral use, notably hypertriglyceridemia and dyslipidemia [6]- [9].…”

Section: Introductionmentioning

confidence: 99%

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Lipodystrophy among Children Infected with Human Immunodeficiency Virus and on Antiretroviral Treatment in Ouagadougou

Yonaba¹,

Ouedraogo²,

Ouédraogo³

et al. 2015

OJPed

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Management of Human Immunodeficiency Virus infection remains a major challenge in many sub-Saharan African countries. Antiretroviral drugs which have reduced significantly the mortality rate of this pandemic disease are a source of side effects. Among these side effects, adult lipodystrophy has already been described by several authors. The aim of this study is to determine the prevalence of lipodystrophy and associate factors in children on antiretroviral therapy, managed at Charles De Gaulle Children University Hospital and Yalgado Ouedrago University Hospital in Ouagadougou, Burkina Faso. This is a cross-sectional study conducted from June 2013 to January 2014. We included children aged 2 to 15 years who had been on antiretroviral treatment for at least six months with no severe acute malnutrition (wasting). Lipodystrophy was diagnosed clinically after assessment of morphological changes. Overall, 323 children complying with the inclusion criteria were examined. The average duration of antiretroviral therapy was 5.3 years. Forty five children had lipodystrophy, i.e. 13.9% prevalence rate. One hundred and twenty seven different lipodystrophic lesions were noted, hence 82.7% lipoatrophy and 17.3% lipohypertrophy. The most common presentations were: face (32%), lower limbs (26%) and upper limbs (15.7%). Factors associated with lipoatrophy were: age above 10 years (P = 0.004); male gender (P = 0.0004); antiretroviral treatment duration of more than 60 months (P < 0.001) and treatment with stavudine (P = 0.01). Our study showed that lipodystrophy is not exceptional in children on antiretroviral therapy in Ouagadougou. However, more researches on lipid profiles of these children are necessary to prevent other common complications related to fat accumulation.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Lipodystrophy among Children Infected with Human Immunodeficiency Virus and on Antiretroviral Treatment in Ouagadougou

Yonaba¹,

Ouedraogo²,

Ouédraogo³

et al. 2015

OJPed

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“…There is a dearth of data on dysglycaemia among HIV-infected children, although a Thailand study revealed that about 4% had hyperglycaemia in a cohort of ART experienced children (non-PI based) 13 . Several studies [14][15][16][17] among HIV-infected Nigerian children have reported a high prevalence of malnutrition, diarrhoeal disease, pneumonia, septicaemia and malaria, all of which are known confounders of hypoglycaemia 18-22 and hyperglycaemia 18,23,24 outside the context of HIV infection.…”

Section: Introductionmentioning

confidence: 99%

“…HIV pancreatic dysfunctions manifest clinically as hypoglycaemia and hyperglycemia [7][8][9][10][11][12][13][14][15] and are seen in both antiretroviral therapy (ART)-experienced and ART-naïve patients 11,12 . The mechanisms of HIV pancreatic dysfunctions include pancreatic infection by HIV and other opportunistic organisms including cytomegalovirus and toxoplasma 7 , infiltration of the pancreatic gland by malignancies 7 , and the effects of therapeutic interventions [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of dysglycaemia and its risk factors in a cohort of human immunodeficiency virus infected antiretroviral therapy naïve children in Makurdi, Nigeria

Anígilájé

2017

Sri Lanka J Child Health

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Background: Human immunodeficiency virus (HIV) endocrinopathy involving the pancreas manifests clinically as dysglycaemia, including hypoglycaemia and hyperglycaemia. Dysglycaemia increases mortality in sick children, underlying the need for its evaluation and management.Objective: To assess the prevalence and risk factors of dysglycaemia in a cohort of antiretroviral therapy (ART)-naïve children at the point of enrolment into a paediatric ART clinic of the Federal Medical Centre, Makurdi, Nigeria. Method:A retrospective cross-sectional study was carried out between June 2010 and June 2012. Hypoglycaemia was defined as random blood glucose level ˂2.2 mmol/l and hyperglycaemia as random blood glucose ˃6.6 mmol/l. Potential risk factors of dysglycaemia were tested for significance in bivariate and multivariate regression analyses. Pvalue less than 0.05 was considered to be significant.Results: 429 children, aged 1-15 years, including 223 males and 206 females were studied. The median age was 5 years. Twelve (2.8%) children had hypoglycaemia and 35 (8.2%) had hyperglycaemia. In multivariate regression analysis, no factor significantly predicted the risk of hypoglycaemia, whereas children co-infected with hepatitis C were at a significant risk of hyperglycaemia (adjusted odds ratio; 2.06, 95% CI; 1.05-8.52, P=0.03). Conclusions:In this study HIV-infected Nigerian children who were not on ART had a low prevalence of hypoglycaemia but a high prevalence of hyperglycaemia. Hepatitis C co-infection was a significant independent risk factor for hyperglycaemia. _________________________________________

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A Population Pharmacokinetic/Pharmacodynamic Model Predicts Favorable HDL Cholesterol Changes Over the First 5 Years in Children Treated With Current Efavirenz‐Based Regimens

Homkham

Cressey

Ingsrisawang

et al. 2016

The Journal of Clinical Pharma

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Efavirenz use is associated with changes in cholesterol concentrations, but it is unclear whether this effect is related to drug concentrations. Using efavirenz and cholesterol plasma concentrations measured in 87 antiretroviral-naive children in Thailand, we assessed indirect response models to describe the evolution of high- and low-density lipoprotein (HDL, LDL) cholesterol concentrations in relation to efavirenz plasma concentrations over time where efavirenz was assumed to either stimulate cholesterol production or inhibit its elimination. Simulations of cholesterol evolution for children with different average efavirenz concentrations (Cav ) according to their assumed status of "fast" or "slow" metabolizers of efavirenz were performed. At treatment initiation, children's median (interquartile range, IQR) age was 8 years (5 to 10), body mass index z-score 0.01 (-1.05 to 1.44), HDL 31 mg/dL (24 to 44), and LDL 83 mg/dL (69 to 100). Median (IQR) efavirenz Cav was 1.7 mg/L (1.3 to 2.1) during the period of observation. The best model describing the evolution of HDL and LDL cholesterol concentrations over time assumed that efavirenz inhibited their elimination. HDL concentrations increase over 5 years, whereas LDL concentrations increased only during the first 4 months and then returned to baseline levels afterward. Simulations predicted that, after 3 years, HDL would increase to 63 mg/dL in "fast" metabolizers and 97 mg/dL in "slow" metabolizers of efavirenz. The population pharmacokinetic-pharmacodynamic (PK-PD) model shows that favorable HDL cholesterol changes can be expected in children with current efavirenz dosing guidelines over 5 years of treatment.

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Recovery From Lipodystrophy in HIV–infected Children After Substitution of Stavudine With Zidovudine in a Non-nucleoside Reverse Transcriptase Inhibitor–based Antiretroviral Therapy

Abstract: Substitution of stavudine with zidovudine resulted in decreased severity or resolution of LD among HIV-infected children and adolescents.

Cited by 38 publications

References 21 publications

Lipodystrophy among Children Infected with Human Immunodeficiency Virus and on Antiretroviral Treatment in Ouagadougou

Lipodystrophy among Children Infected with Human Immunodeficiency Virus and on Antiretroviral Treatment in Ouagadougou

A retrospective analysis of dysglycaemia and its risk factors in a cohort of human immunodeficiency virus infected antiretroviral therapy naïve children in Makurdi, Nigeria

A Population Pharmacokinetic/Pharmacodynamic Model Predicts Favorable HDL Cholesterol Changes Over the First 5 Years in Children Treated With Current Efavirenz‐Based Regimens

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