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Session 134 Poster Abstracts
Complications in Pediatric HIV Infection
Thursday, 1:30 - 3:30 pm
Hall B


775    
Prevalence of Lipodystrophy and Hyperlipidemia in a Large Cohort of HIV-infected Children
Jose T Ramos*1, S Guillen1, R Resino2, J Bellón2, M de Jose1, M Gonzalez-tome1, M Gurbindo3, M Navarro1, M Mellado4, P Martin-Fontelos4, J Beceiro5, J Martinez-Perez6, M Roa7, B Rubio8, M Muñoz-Fernandez2, and for the Madrid Cohort of HIV-infected children
1Hosp 12 de Octubre, Madrid, Spain; 2Hosp Gregorio Marañon, Madrid, Spain; 3Hosp Gregorio Marañon, Madrid, Spain; 4Hosp Carlos III, Madrid, Spain; 5Hosp Alcala de Henares, Madrid, Spain; 6Hosp Niño Jesus, Madrid, Spain; 7Hosp Mostoles, Madrid, Spain; and 8Hosp Getafe, Madrid, Spain

Background:  Most HIV-infected children are currently being treated with HAART. Metabolic complications associated with HAART are increasingly being recognized in children and of major concern. Lipodystrophy and dyslipidemia have been assessed in few large pediatric studies. The aim of this study has been to estimate the prevalence of lipodystrophy and hyperlipidemia in children and to analyze possible associated risk factors.

Methods:  Observational study of all patients followed in 9 centers in Madrid from a cohort of HIV-infected children. The cohort was set up in January 2003 with prospective data collection every 6 months at each centre, according to an standardized protocol. Assessment of fat distribution was done by clinical criteria, anthropometric measurements and in a subset of 62 children also by DEXA. Lipodystrophy was defined on clinical grounds at last observation. Hyperlipidemia was defined as plasma cholesterol and triglycerides levels above 200 and 170 mg/dL, respectively, at the last visit. Multivariated analysis of risk factors was done by logistic regression.

Results:  As of October 2004, 258 HIV-infected children have been followed, 97% perinatally infected. Median age was 12.3 years (0.5 to 22). 28% and 47% were on CDC class C and 3, respectively. Median CD4 count was 771 cells/mm3 (75 to 3492%), and 58% had plasma HIV RNA below 400 copies/mL; 10% of children are not treated, 5% remain on dual therapy, and 85% are receiving HAART. Median duration of HAART has been 68 months (3 to 99). Any type of lipodystrophy was detected in 98 children (prevalence 38%, 95% CI, 32 to 44%). Among them, 38% had lipoatrophy, 21% lipohypertrophy and 41% the combined subtype. Hypercholesterolemia was detected in 31% and hypertriglyceridemia in 17% of children. Risk factors significantly associated with lipodystrophy in univariate analysis included older age, female gender, CDC class C, stavudine (d4T), indinavir, and duration of HAART. Multivariate analysis identified female gender (OR 2.2, CI 1.2 to 4.1) and d4T exposure (OR 9.8, CI 1.2 to 81) as independent risk factors associated with lipodystrophy.

Conclusions:  In the Madrid cohort of HIV-infected children there is a high prevalence of lipodystrophy and hyperlipidemia. Independent risk factors associated with lipodystrophy are female gender and d4T exposure.

 

 

Keywords: children; lipodystrophy; hyperlipidemia