Lipodystrophy is common in children from three European cohorts

Simon Collins, HIV i-Base

Researchers from 14 sites in Belgium, Poland and Italy reported the prevalence of lipodystrophy in a cohort of 468 children and adolescents (92% infected at birth).

Data collected included demographic and clinical history and used standardised assessment to determine fat loss or accumulation in the face, limbs, buttocks, breasts, neck and trunk.

The cohort was evenly split by gender, with median age 13.5 years (IQR 9.9-17.0). Tanner puberty stage included 28% stage I and 34% stage V. In this group, 73% were white and 22% Black African. HIV treatment was used by 95% of the cohort for a median 8.8 years, with 62% having viral load suppressed <50 copies/mL. The median CD4% was 31% (IQR 24-38) and just over 300 children were currently asymptomatic.

Assessment of symptoms was by clinician-completed questionnaire. Over 40% of children had at least one lipodystrophy symptom: 15% had just fat loss, 13% just fat accumulation (mostly trunk) and 13% had both symptoms. This group included 14 cases of severe fat accumulation and 11 cases of both severe fat loss and fat accumulation.

In multivariate analysis, after controlling for duration of treatment, maternal lipodystrophy, maximal CDC status, and having ever used d4T, indinavir, d-drugs and efavirenz, significant associations were found for d4T use (AOR 4.23; 2.02, 8.85), efavirenz use (AOR=2.72; 1.36, 5.46), indinavir use (AOR 3.23) and clinical stage (AOR 3.30; 1.28, 8.02) and either fat loss or fat accumulation.

Even stronger associations were found for children who had both symptoms.

Maternal lipodystrophy was also associated with an adjusted OR of 3.01 (1.78, 5.57) for any symptom and 4.75 (1.60, 14.20) for both symptoms.

Ref: Alam NM et al. Risk factors for body fat redistribution in a European cohort of HIV-infected children and adolescents. 11th Intl Workshop on Adverse Drug Reactions. 26-28 October 2009, Philadelphia. Poster abstract P-06. Antiviral therapy 2009; 14 Suppl 2: A27.

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