649   Antiretroviral-Associated Lipodystrophy Syndrome in HIV- Infected Children.

R. A. Amaya* and M. W. Kline .
Baylor Coll. of Med. and Texas Children's Hosp., Houston.

Background:Antiretroviral-associated lipodystrophy syndrome is a condition observed in HIV-infected adults that is characterized by a variety of physical and/or metabolic abnormalities. Physical features include fat redistribution, fat wasting of face and extremities, with fat accumulation in the abdomen and/or dorsocervical spine, and breast enlargement in women. Metabolic abnormalities include hypercholesterolemia, hypertriglyceridemia, and insulin resistance. Although the pathogenesis of the condition is debated, many studies suggest an association with highly active antiretroviral therapy (HAART). The objective of this study is to evaluate the prevalence of antiretroviral-associated lipodystrophy syndrome in HIV-infected children.

Methods:This is a cross-sectional study evaluating HIV-infected children, aged 2—16 years, recruited from an ambulatory pediatric HIV clinic. Medical, antiretroviral and nutritional histories are being obtained from each participant. Fasting blood analyses include cholesterol, triglycerides, glucose, insulin and C-peptide levels. Fat wasting is being identified by patient/parental self-questionnaire and confirmed by physical exam.

Results:As of October 2000, 35 HIV-infected children (mean age, 9.2 years; range, 2.9 to 15.8 years) have been evaluated. Seven patients exhibited physical signs of lipodystrophy. The following metabolic abnormalities were observed: hypercholesterolemia (19 patients), hypertriglyceridemia (10 patients), and insulin resistance (3 patients). Ten patients did not exhibit any physical or laboratory evidence of lipodystrophy. A review of each participant's treatment history revealed no definitive association between a specific antiretroviral regimen and the development of physical or metabolic abnormalities of lipodystrophy. Analysis of nutritional history as an independent risk factor for the development of lipodystrophy is in progress.

Conclusions:Antiretroviral-associated lipodystrophy syndrome does occur in HIV-infected children. Hypercholesterolemia and hypertriglyceridemia are the abnormalities most commonly observed. Development of physical abnormalities and insulin resistance is less common. Preliminary data suggest that no specific antiretroviral drug regimen is associated with the development of lipodystrophy.