Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of lipodystrophy in HIV-infected children: a cross-sectional study

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to assess the changes in body fat distribution and lipid abnormalities in a population of HIV-infected children and adolescents followed in one single centre who had been exposed, or not, to antiretroviral therapy (ART).

Materials and methods

Patients aged between 3 and 19 years were evaluated in a cross-sectional study carried out between October and December 2002. Fat redistribution was evaluated independently by the physician and the patient. Fasting blood lipid profile, glucose, insulin and C peptide were measured. Among the 88 patients evaluated, 74 were taking ART.

Results

Fat redistribution was present in 20 patients, metabolic alterations alone were found in 22 children and 46 children had neither physical nor metabolic abnormalities. Patients with fat redistribution were found to have been on ART for a significantly longer period of time, with 42% of the children showing fat redistribution having been treated with anitretroviral agents for more than 5 years. These children had also been exposed to a higher number of antiretroviral agents. In contrast, metabolic alterations in the absence of fat redistribution were not related to the duration of ART nor to the number of drugs received. Treatment with stavudine or protease inhibitors was significantly associated with the presence of physical changes.

Conclusion

Regular assessment of fat redistribution and metabolic markers should be carried out in children treated with antiretroviral agents and taken into account when adapting therapy during the long-term follow up of these children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ART:

Antiretroviral therapy

BMI:

Body mass index

D4T:

Stavudine

HAART:

Highly active antiretroviral therapy

HIV:

Human immunodeficiency virus

NNRTI:

Non-nucleoside reverse transcriptase inhibitors

NRTI:

Nucleoside reverse transcriptase inhibitors

PI:

Protease inhibitors

References

  1. Amaya RA, Kozinetz CA, McMeans A, Schwarzwald H, Kline MW (2002) Lipodystrophy syndrome in human immunodeficiency virus- infected children. Pediatr Infect Dis J 21:405–410

    Article  PubMed  Google Scholar 

  2. Arpadi SM, Cuff PA, Horlick M, Kotler DP (1999) Visceral obesity, hypertriglyceridemia and hypercortisolism in a boy with perinatally acquired HIV infection receiving protease inhibitor- containing antiviral treatment. AIDS 13:2312–2313

    Article  PubMed  CAS  Google Scholar 

  3. Arpadi SM, Cuff PA, Horlick M, Wang J, Kotler DP (2001) Lipodystrophy in HIV- infected children is associated with high viral load and low CD4+ - lymphocyte count and CD4+ - lymphocyte percentage at baseline and use of protease inhibitors and stavudine. J Acquir Immune Defic Syndr 27:30–34

    PubMed  CAS  Google Scholar 

  4. Babl FE, Regan AM, Pelton SI (1999) Abnormal body- fat distribution in HIV- 1- infected children on antiretrovirals. Lancet 353:1243–1244

    Article  PubMed  CAS  Google Scholar 

  5. Belloso WH, Quiros RE, Ivalo SA, Perman MI, Galich AM, Stern LD, Barcan LA (2003) Agreement analysis of variables involved in lipodystrophy syndrome definition in HIV- infected patients. J Acquir Immune Defic Syndr 32:104–111

    PubMed  Google Scholar 

  6. Beregszaszi M, Jaquet D, Levine M, Ortega-Rodriguez E, Baltakse V, Polak M, Levy-Marchal C (2003) Severe insulin resistance contrasting with mild anthropometric changes in the adipose tissue of HIV- infected children with lipohypertrophy. Int J Obes Relat Metab Disord 27:25–30

    Article  PubMed  CAS  Google Scholar 

  7. Bockhorst JL, Ksseiry I, Toye M, Chipkin SR, Stechenberg BW, Fisher DJ, Allen HF (2003) Evidence of human immunodeficiency virus- associated lipodystrophy syndrome in children treated with protease inhibitors. Pediatr Infect Dis J 22:463–465

    Article  PubMed  Google Scholar 

  8. Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA (2003) Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 348:702–710

    Article  PubMed  CAS  Google Scholar 

  9. Brambilla P, Bricalli D, Sala N, Renzetti F, Manzoni P, Vanzulli A, Chiumello G, di Natale B, Vigano A (2001) Highly active antiretroviral- treated HIV- infected children show fat distribution changes even in absence of lipodystrophy. AIDS 15:2415–2422

    Article  PubMed  CAS  Google Scholar 

  10. Brunton JA, Bayley HS, Atkinson SA (1993) Validation and application of dual-energy X-ray absorptiometry to measure bone mass and body composition in small infants. Am J Clin Nutr 58:839–845

    PubMed  CAS  Google Scholar 

  11. Carr A, Cooper DA (2000) Adverse effects of antiretroviral therapy. Lancet 356:1423–1430

    Article  PubMed  CAS  Google Scholar 

  12. Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA (1999) Diagnosis, prediction, and natural course of HIV- 1 protease- inhibitor- associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 353:2093–2099

    Article  PubMed  CAS  Google Scholar 

  13. Carr A, Miller J, Law M, Cooper DA (2000) A syndrome of lipoatrophy, lactic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: contribution to protease inhibitor- related lipodystrophy syndrome. AIDS 14:F25–F32

    Article  PubMed  CAS  Google Scholar 

  14. Carr A, Emery S, Law M, Puls R, Lundgren JD, Powderly WG (2003) An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. Lancet 361:726–735

    Article  PubMed  CAS  Google Scholar 

  15. CDC (1994) 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Recomm Rep 43:1–10

    Google Scholar 

  16. Charakida M, Donald AE, Green H, Storry C, Clapson M, Caslake M, Dunn DT, Halcox JP, Gibb DM, Klein NJ, Deanfield JE (2005) Early structural and functional changes of the vasculature in HIV-infected children: impact of disease and antiretroviral therapy. Circulation 112:103–109

    Article  PubMed  Google Scholar 

  17. Cheseaux JJ, Jotterand V, Aebi C, Gnehm H, Kind C, Nadal D, Rudin C, Lazarevitch CA, Nicod P, Mooser V (2002) Hyperlipidemia in HIV-infected children treated with protease inhibitors: relevance for cardiovascular diseases. J Acquir Immune Defic Syndr 30:288–293

    PubMed  CAS  Google Scholar 

  18. d’Arminio A, Sabin CA, Phillips AN, Reiss P, Weber R, Kirk O, El-Sadr W, De Wit S, Mateu S, Petoumenos K, Dabis F, Pradier C, Morfeldt L, Lundgren JD, Friis-Moller N (2004) Cardio- and cerebrovascular events in HIV-infected persons. AIDS 18:1811–1817

    PubMed  CAS  Google Scholar 

  19. Foulkes AS, Wohl DA, Frank I, Puleo E, Restine S, Wolfe ML, Dube MP, Tebas P, Reilly MP (2006) Associations among race/ethnicity, ApoC-III genotypes, and lipids in HIV-1-infected individuals on antiretroviral therapy. PLoS Med. 3(3):e52

    Article  PubMed  Google Scholar 

  20. Friis-Moller N, Sabin CA, Weber R, d'Arminio Monforte A, El- Sadr WM, Reiss P, Thiebaut R, Morfeldt L, De Wit S, Pradier C, Calvo G, Law MG, Kirk O, Phillips AN, Lundgren JD (2003) Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 349:1993–2003

    Article  PubMed  Google Scholar 

  21. Group EPL (2004) Antiretroviral therapy, fat redistribution and hyperlipidemia in HIV-infected children in Europe. AIDS 18:1443–1451

    Google Scholar 

  22. Grunfeld C, Kotler DP, Hamadeh R, Tierney A, Wang J, Pierson RN (1989) Hypertriglyceridemia in the acquired immunodeficiency syndrome. Am J Med 86:27–31

    Article  PubMed  CAS  Google Scholar 

  23. Jaquet D, Levine M, Ortega-Rodriguez E, Faye A, Polak M, Vilmer E, Levy-Marchal C (2000) Clinical and metabolic presentation of the lipodystrophic syndrome in HIV-infected children. AIDS 14:2123–2128

    Article  PubMed  CAS  Google Scholar 

  24. Joly V, Flandre P, Meiffredy V, Leturque N, Harel M, Aboulker JP, Yeni P (2002) Increased risk of lipoatrophy under stavudine in HIV-1-infected patients: results of a substudy from a comparative trial. AIDS 16:2447–2454

    Article  PubMed  CAS  Google Scholar 

  25. Lainka E, Oezbek S, Falck M, Ndagijimana J, Niehues T (2002) Marked dyslipidemia in human immunodeficiency virus-infected children on protease inhibitor- containing antiretroviral therapy. Pediatrics 110:e56

    Article  PubMed  Google Scholar 

  26. Mallal SA, John M, Moore CB, James IR, McKinnon EJ (2000) Contribution of nucleoside analogue reverse transcriptase inhibitors to subcutaneous fat wasting in patients with HIV infection. AIDS 14:1309–1316

    Article  PubMed  CAS  Google Scholar 

  27. Martinez E, Mocroft A, Garcia-Viejo MA, Perez-Cuevas JB, Blanco JL, Mallolas J, Bianchi L, Conget I, Blanch J, Phillips A, Gatell JM (2001) Risk of lipodystrophy in HIV- 1- infected patients treated with protease inhibitors: a prospective cohort study. Lancet 357:592–598

    Article  PubMed  CAS  Google Scholar 

  28. Mauss S, M Corzillius, E Wolf, A Schwenk, A Adam, H Jaeger, H Knechten, J Goelz, A Goetzenich (2002) Risk factors for the HIV-associated lipodystrophy syndrome in a closed cohort of patients after 3 years of antiretroviral treatment. HIV Med 3:49–55

    Article  PubMed  CAS  Google Scholar 

  29. McComsey GA, Leonard E (2004) Metabolic complications of HIV therapy in children. AIDS 18:1753–1768

    Article  PubMed  Google Scholar 

  30. Miller KD, Jones E, Yanovski JA, Shankar R, Feuerstein I, Falloon J (1998) Visceral abdominal-fat accumulation associated with use of indinavir. Lancet 351:871–875

    Article  PubMed  CAS  Google Scholar 

  31. Moser W Hugo (2002) Nelson textbook of pediatrics, 17th edn. In: Behrman RE, Jenson HB (ed) Defects in metabolism of lipids. Nelson textbook of pediatrics. Saunders, Elsevier Science, Amsterdam

  32. Nolan D, Mallal S (2005) Antiretroviral therapy-associated lipoatrophy: current status and future directions. Sex Health 2:153–163

    Article  PubMed  Google Scholar 

  33. Owens S, B Gutin, M Ferguson, J Allison, W Karp, NA Le (1998) Visceral adipose tissue and cardiovascular risk factors in obese children. J Pediatr 133:41–45

    Article  PubMed  CAS  Google Scholar 

  34. Roemmich JN, Clark PA, Lusk M, Friel A, Weltman A, Epstein LH, Rogol AD (2002) Pubertal alterations in growth and body composition. VI. Pubertal insulin resistance: relation to adiposity, body fat distribution and hormone release. Int J Obes Relat Metab Disord 26:701–709

    Article  PubMed  CAS  Google Scholar 

  35. Saint-Marc T, Partisani M, Poizot-Martin I, Bruno F, Rouviere O, Lang JM, Gastaut JA, Touraine JL (1999) A syndrome of peripheral fat wasting (lipodystrophy) in patients receiving long- term nucleoside analogue therapy. AIDS 13:1659–1667

    Article  PubMed  CAS  Google Scholar 

  36. Sanchez Torres AM, R Munoz Muniz, R Madero, C Borque, MJ Garcia- Miguel, MI De Jose Gomez (2005) Prevalence of fat redistribution and metabolic disorders in human immunodeficiency virus- infected children. Eur J Pediatr

  37. Taylor P, Worrell C, Steinberg SM, Hazra R, Jankelevich S, Wood LV, Zwerski S, Yarchoan R, Zeichner S (2004) Natural history of lipid abnormalities and fat redistribution among human immunodeficiency virus- infected children receiving long- term, protease inhibitor- containing, highly active antiretroviral therapy regimens. Pediatrics 114:e235–e242

    Article  PubMed  Google Scholar 

  38. Temple ME, Koranyi KI, Nahata MC (2003) Lipodystrophy in HIV- infected pediatric patients receiving protease inhibitors. Ann Pharmacother 37:1214–1218

    Article  PubMed  CAS  Google Scholar 

  39. Thiebaut R, V Daucourt, P Mercie, DK Ekouevi, D Malvy, P Morlat, M Dupon, D Neau, S Farbos, C Marimoutou, F Dabis (2000) Lipodystrophy, metabolic disorders, and human immunodeficiency virus infection: Aquitaine Cohort, France, 1999. Groupe d'Epidemiologie Clinique du Syndrome d'Immunodeficience Acquise en Aquitaine. Clin Infect Dis 31:1482–1487

    Article  PubMed  CAS  Google Scholar 

  40. van der Valk M, EH Gisolf, P Reiss, FW Wit, A Japour, GJ Weverling, SA Danner (2001) Increased risk of lipodystrophy when nucleoside analogue reverse transcriptase inhibitors are included with protease inhibitors in the treatment of HIV-1 infection. AIDS 15:847–855

    Article  PubMed  Google Scholar 

  41. Vigano A, Mora S, Testolin C, Beccio S, Schneider L, Bricalli D, Vanzulli A, Manzoni P, Brambilla P (2003) Increased lipodystrophy is associated with increased exposure to highly active antiretroviral therapy in HIV- infected children. J Acquir Immune Defic Syndr 32:482–489

    PubMed  Google Scholar 

  42. Worm D, Kirk O, Andersen O, Vinten J, Gerstoft J, Katzenstein TL, Nielsen H, Pedersen C (2002) Clinical lipoatrophy in HIV-1 patients on HAART is not associated with increased abdominal girth, hyperlipidaemia or glucose intolerance. HIV Med 3:239–246

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the patients and their families for their collaboration. We are grateful to Claire Thorne and Drs. Edwige Haelterman, Claudine Heinrich and Melanie Newport for revising the manuscript, and to Michèle Dramaix for her statistical advice. This study was funded by the Smiles Foundation, Belgium, and L. Ene received a grant from the European AIDS Clinical Society (EACS).

Author information

Authors and Affiliations

  1. Department of Pediatric AIDS, “Dr. Victor Babes” Hospital for Infectious Disease, 281 Sos Mihai Bravu, Sector 3, Bucharest, Romania

    Luminita Ene

  2. Department of Pediatrics, Hopital St. Pierre, 322 rue haute, Brussels, 1000, Belgium

    Tessa Goetghebuer, Marc Hainaut, Alexandra Peltier, Véronique Toppet & Jack Levy

Authors
  1. Luminita Ene
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tessa Goetghebuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Hainaut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandra Peltier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Véronique Toppet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jack Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tessa Goetghebuer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ene, L., Goetghebuer, T., Hainaut, M. et al. Prevalence of lipodystrophy in HIV-infected children: a cross-sectional study. Eur J Pediatr 166, 13–21 (2007). https://doi.org/10.1007/s00431-006-0193-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-006-0193-1

Keywords

Search

Navigation