Prevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy.

Abstract

BACKGROUND:

Most pediatric lipodystrophy data come from high-income/middle-income countries, but most HIV-infected children live in sub-Saharan Africa, where lipodystrophy studies have predominantly investigated stavudine-based regimens.

METHODS:

Three years after antiretroviral therapy (ART) initiation, body circumferences and skinfold thicknesses were measured (n = 590), and fasted lipid profile assayed (n = 325), in children from 2 ARROW trial centres in Uganda/Zimbabwe. Analyses compared randomization to long-term versus short-term versus no zidovudine from ART initiation [unadjusted; latter 2 groups receiving abacavir+lamivudine+non-nucleoside-reverse-transciptase-inhibitor (nNRTI) long-term], and nonrandomized (confounder-adjusted) receipt of nevirapine versus efavirenz.

RESULTS:

Body circumferences and skinfold thicknesses were similar regardless of zidovudine exposure (P > 0.1), except for subscapular and supra-iliac skinfolds-for-age which were greater with long-term zidovudine (0.006 < P < 0.047). Circumferences/skinfolds were also similar with efavirenz and nevirapine (adjusted P > 0.09; 0.02 < P < 0.03 for waist/waist-hip-ratio). Total and high-density lipoprotein (HDL)-cholesterol, HDL/triglyceride-ratio (P < 0.0001) and triglycerides (P = 0.01) were lower with long-term zidovudine. Low-density lipoprotein (LDL)-cholesterol was higher with efavirenz than nevirapine (P < 0.001). Most lipids remained within normal ranges (75% cholesterol, 85% LDL and 100% triglycerides) but more on long-term zidovudine (3 NRTI) had abnormal HDL-cholesterol (88% vs. 40% short/no-zidovudine, P < 0.0001). Only 8/579(1.4%) children had clinical fat wasting (5 grade 1; 3 grade 2); 2(0.3%) had grade 1 fat accumulation.

CONCLUSIONS:

Long-term zidovudine-based ART is associated with similar body circumferences and skinfold thicknesses to abacavir-based ART, with low rates of lipid abnormalities and clinical lipodystrophy, providing reassurance where national programs now recommend long-term zidovudine. Efavirenz and nevirapine were also similar; however, the higher LDL observed with efavirenz and lower HDL observed with zidovudine suggests that zidovudine+lamivudine+efavirenz should be investigated in future.

• Authors: Mutsawashe Bwakura-Dangarembizi, Victor Musiime, Alexander J Szubert, Andrew J Prendergast, Zvenyika A Gomo, Margaret J Thomason, Cuthbert Musarurwa, Peter Mugyenyi, Patricia Nahirya, Adeodata Kekitiinwa, Diana M Gibb, Ann S Walker, Kusum Nathoo, ARROW Trial Team
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 34 Issue 2 Pg. e23-31 (Feb 2015) ISSN: 1532-0987 [Electronic] United States
• PMID: 25068287 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Retroviral Agents
• Lipids

Topics

• Adolescent
• Anti-Retroviral Agents (adverse effects, therapeutic use)
• Antiretroviral Therapy, Highly Active (adverse effects, methods)
• Body Fat Distribution
• Child
• Child, Preschool
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Infant
• Lipids (blood)
• Lipodystrophy (chemically induced, epidemiology)
• Male
• Prevalence
• Uganda (epidemiology)
• Zimbabwe (epidemiology)