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Prospective Follow-up of HIV-infected Children and Young People with Lipodystrophy
Alessandra Vigaṇ*1, V Giacomet1, L Martelli1, C Thorne2, and on behalf of the Italian Members of European Paediatric Lipodystrophy Group
1Hosp Luigi Sacco, Milan, Italy and 2Inst of Child Hlth, London, UK
Background: There are limited prospective data on lipodystrophy
in HIV-infected children, particularly regarding changes over puberty and the
prognostic value and clinical significance of the different types of fat
redistribution and lipid/glucose abnormalities.
Methods: Follow-up data on 55 HIV-infected children and adolescents (32 female,
23 male) with lipodystrophy syndrome from 12 Italian pediatric centers,
who were identified in a cross-sectional study in 2003 were collected in June
to November 2004. The follow up data include clinical characteristics,
laboratory tests, ART, and management of lipodystrophy
symptoms.
Results: Median age was 14.1 years (range 8.2 to 22.0) at the follow-up data
collection. Regarding HIV disease progression, 3 had no HIV symptoms, 12 (22%)
were in CDC class A, 22 (40%) in class B, and 18 (33%) in class C; only 2
children overall had evidence of severe immune suppression (CD4% <15%). Of
32 children with recent HIV RNA measurements, 18 were undetectable (14 <50
and 4 <500 copies/mL) and 14 detectable (median 5865
copies/mL, maximum 360,000). All children were
ART-experienced, and all were taking HAART, except 1 child who had stopped all
ART at the age of 15 years. For 22 (40%) children, the reason, or 1 of the
reasons, for prior ART modifications had been body composition changes or dyslipidemia. Clinical signs of fat redistribution were
present in 49 (89%): 9 had central lipohypertrophy only, 13 peripheral lipoatrophy
only, and the remaining 27 had the combined sub-type. Nine children (median age
14.5 years, 3 male) had severe lipoatrophy (median 4
sites, median body mass index 17.8) and a further 11 had severe central lipohypertrophy (median age 12.3 years, median body mass
index 21.6, median waist:hip
ratio 0.92 girls, 0.98 boys). Hypertriglyceridemia
was present in 19 (35%) children and hypercholesterolemia in 14 (25%) (8
children had both concurrently). Ten (18%) children had received drug treatment
for lipodystrophy (9 human growth hormone, 1 phenofibrate); of these 8 were receiving other
interventions (3 dietary, 5 physical activity, 1
surgical).
Conclusions: Lipodystrophy syndrome arising in childhood does
not appear to resolve in the majority of cases, although, once established,
symptoms of fat redistribution seemed relatively stable.
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