Background:  Antiretroviral therapy has profoundly improved the clinical outcomes and quality of life of HIV-infected children. However with widespread use and increased duration of treatment, metabolic toxicities are becoming more evident. Fat redistribution has been reported in HIV-infected children with a prevalence of 18% to 33%. Little is known about lipodystrophy in children in Uganda yet increasing numbers of children infected with HIV are getting started on HAART. Therefore this study aims to determine the prevalence and factors associated with fat redistribution and metabolic abnormalities among HIV positive children aged 2 to 18 years on HAART for at least 6 months.

Methods: This was a cross sectional study of 364 eligible participants enrolled consecutively after consent and assent from February 2009 to March 2009. Sociodemographic, clinical and immunological data was collected and recorded in a questionnaire. Assessment for abnormal fat redistribution was done clinically by the physical findings of lipohypertrophy and lipoatrophy. A fasting blood sample was taken for a lipid profile and blood glucose analysis.

Data was entered using EPIDATA package version 3.1, analyzed using stata version 9.2.

Results: The median age of the participants was 8 years (range 2 to 18) with a male to female ratio of 1.1:1. The prevalence of fat redistribution and hyperlipidemia was 27.0% and 34.0%, respectively. None of the children had hyperglycemia. Among the children with hyperlipidemia only 16.8% exhibited hypercholesterolemia and 83% had hypertriglyceridemia. Only 29% of children with fat redistribution had hyperlipidemia. On multivariate analysis fat redistribution was independently associated with Tanner stages 2 to 5 (P =0.003), age ≥5 years (P =0.005) and D4T exposure (P =0.000). A tanner stage 2 to 5 was independently associated with hyperlipidemia. No significant association was found between lipodystrophic features and patient gender, HIV clinical stage and any of the anthropometric measurements.

Conclusion:  The prevalence of lipodystrophy is high, at 53% among HIV⁺ children on HAART with a likelihood of developing fat redistribution and metabolic abnormalities increased during puberty. Therefore, active screening for fat redistribution and metabolic complications should be instituted & reinforced in pediatric HIV care centers.