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

TitlePrevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy.
Publication TypeJournal Article
Year of Publication2015
AuthorsBwakura-Dangarembizi, M, Musiime, V, Szubert, AJ, Prendergast, AJ, Gomo, ZA, Thomason, MJ, Musarurwa, C, Mugyenyi, P, Nahirya, P, Kekitiinwa, A, Gibb, DM, Walker, AS, Nathoo, K
Corporate AuthorsARROW Trial Team
JournalPediatr Infect Dis J
Volume34
Issue2
Paginatione23-31
Date Published2015 Feb
ISSN1532-0987
KeywordsAdolescent, Anti-Retroviral Agents, Antiretroviral Therapy, Highly Active, Body Fat Distribution, Child, Child, Preschool, Female, HIV Infections, Humans, Infant, Lipids, Lipodystrophy, Male, Prevalence, Uganda, Zimbabwe
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.

DOI10.1097/INF.0000000000000491
Alternate JournalPediatr. Infect. Dis. J.
PubMed ID25068287
PubMed Central IDPMC4369579
Grant List093768 / / Wellcome Trust / United Kingdom
MC_EX_G0300400 / / Medical Research Council / United Kingdom
MC_U122886353 / / Medical Research Council / United Kingdom
WT 093768/z/10/z / / Wellcome Trust / United Kingdom
/ / Medical Research Council / United Kingdom