774 Fat Redistribution and Metabolic Abnormalities in HIV-infected Children and Adolescents in Europe A. Vigano1, C. Thorne*2, Italian Register on HIV in Children3, European Collaborative Study2 1Hosp L Sacco, Milan, Italy; 2Inst of Child Hlth, London, UK; and 3Italy
Background: Little is known about the characteristics and prevalence of and risk factors for lipodystrophy in children and adolescents. We aimed to estimate the prevalence of both clinical and biochemical signs possibly relating to lipodystrophy in HIV-infected children in Europe.
Methods: Over a 2-3 month period, data on all infected children aged 3-18 yrs attending the participating 23 pediatric HIV clinics was collected including socio-demographic, clinical, immunological and antiretroviral therapy (ART) variables and laboratory assessments of metabolic function. Data were analyzed in SAS, with logistic regression for multivariate analyses.
Results: The analysis included 374 children (196 female, 176 male), with a median age of 5 yrs. Most (276, 74%) children were currently on triple + ART. A total of 106 (28%) children had 1 + clinically determined sign of fat redistribution, of whom 24 (23%) had signs of peripheral lipoatrophy alone (fat wasting of the face, arms, legs or buttocks), 39 (37%) signs of central obesity alone (fat accumulation in the abdomen or dorsocervical spine, or breast enlargement), and 43 (41%) combined lipodystrophy. The most common sites of fat redistribution were the abdomen (21% of 374 children), face (12%), legs (12%), and arms (11%). Dyslipidemia (cholesterol > 199 mg/dl and/or triglycerides >149 mg/dl) was present in 37% (101/270) children, of whom 42% (42/101) also showed fat redistribution. Female gender (AOR 2.08 [95% CI, 1.25-3.47]), CDC clinical stage C (AOR 2.75 [1.45-5.29]) and current use of triple + ART (AOR 3.03 [1.34-6.86]) were significantly and independently associated with any fat redistribution (and also for lipoatrophy and central obesity individually, AORs not shown); additionally age > 12 yrs was significantly associated with development of central obesity (AOR 2.14 [1.08-4.18]). Children on triple + ART were at a substantially increased risk of both fat redistribution and dyslipidemia (AOR 10.99, 95% CI, 3.07-39.35) compared with all other children. Duration of any ART was not significantly associated with fat redistribution or metabolic abnormalities.
Conclusions: We show that between a 1/4 and a 1/3 of children could be taken to have signs of lipodystrophy. Our broad approach allowed us to describe the full range of signs of fat redistribution and metabolic abnormalities and their risk factors in children and adolescents and will be helpful in informing the development of a clinical definition.
