772 High Prevalence of Metabolic Abnormalities in HIV-infected Children Treated with HAART J. T. Ramos*, L. García, P. Rojo, C. Ruano, P. Carreño, J. Ruiz-Contreras, F. Hawkins Hosp 12 de Oct, Madrid, Spain
Background: Lipodystrophy (LD) and decreased bone mineral density are difficult to assess in children, although they are increasingly being recognized in HIV-infected children treated with antiretroviral therapy. These and other common metabolic abnormalities raise concerns for their long-term consequences.
Objectives:To asses the prevalence of metabolic abnormalities including hyperlipidemia, hyperinsulinemia, hyperlactatemia, LD and decreased BMD in HIV-infected children treated with HAART.
Methods: Cross-sectional study of all HIV-infected children followed in our unit treated with HAART in whom Dual X-ray Absorptiometry (DXA) was performed. Simultaneous anthropometric parameters, including skin-fold measurements were determined. At least 2 consecutive increases of fasting plasma samples were required to consider hypercholesterolaemia (> 200 mg/dl), hypertriglyceridemia (> 170 mg/dl), hyperinsulinemia (> 15 U/ml), and hyperlactatemia (> 2.2 mmol/l. LD was defined on clinical grounds consisting of either a decrease in face or limb fat and/or trunkal lipohypertrophy. Osteopenia was defined as a z-score of less than 1 for lumbar spine (L1-L4) scan by DXA (HOLOGIC QDR 4500/W).
Results: Forty-nine (49) white patients (pts) were included (25 female) with a median age of 127 mos (53-219). All but 1 pt acquired HIV through vertical transmission. Fifty-six percent (56%) and 27% of children were on class 3 and C, respectively. The median CD4 was 842 cells and 59% had HIV-RNA below 300 copies/ml. The median length of HAART was 54 mos (16-68). All but 3 children were receiving a PI-containing regimen. Hypercholesterolemia and hypertriglyceridemia were present in 69% and 23%. Hyper-insulinemia was detected in 24% whereas an increase in C peptide occurred in 10%. Hyperlactatemia was observed in 3 children (all asymptomatic). LD was diagnosed in 12 children (11 female) and osteopenia in 21 (38%). The median z-score was -1,64 (-1, 01, -3, 2). LD was not associated with osteopenia, hyperlipidemia, or hyperinsulinemia.
Conclusions: There is a high prevalence of metabolic abnormalities, including lipodystrophy and osteopenia in HIV-infected children treated with HAART. As the long-term consequences are of concern, studies are needed to elucidate its pathogenesis and prevention.
