Lipodystrophy and metabolic changes in children
Some studies addressed prevalence of lipodystrophy in children indicating that this presents a similar concern to that of adults.
Vigano and colleagues from University of Milan looked at lipodystrophy in 34 HIV-positive children on HAART, using DEXA for regional body composition (n=34) and MRI for intraabdominal tissue (n=16).  Six of the HIV-positive children were identified as having lipodystrophy symptoms (LD+) at the start of the study and an HIV-negative control group was used for comparison.
The LD+ and LD children were matched for previous exposure to AZT, d4T and ddI, months on HAART (d4T/3TC plus single PI), CD4 count and plasma RNA <50 copies.
Within the HIV+ group, LD+ children showed higher trunk fat/total fat ratio (p=0.04) and lower limb fat/total fat ratio (P=0.009) and larger intraabdominal tissue (P<0.0003) than LDnegative children. However, there was a significant difference in fat mass and distribution between HIV-positive children as a whole and the control group, although lean mass was similar. Reduced fat quantity and percentage, lower truncal fat mass and markedly reduced limbs fat mass being reported in both the LD+ and LD groups compared to controls. This highlighted the importance of careful monitoring, and the current underdiagnosis of subclinical lipodystrophy that was found in all children on HAART.
The discussion following this presentation highlighted the importance of careful monitoring and that baseline and subsequent DEXA for lipodystrophy in all children treated with HAART is integrated into the clinical care programmes lead by these clinicians.
- Vignano et al – Changes in body fat distribution are detectable in HIVinfected children treated with HAART even in absence of clinical lipodystrophy. Abstract 13. Antiviral Therapy 2001; 6 (Supplement 4):10.