2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13-15 September 2000, Toronto, Canada

CHANGES IN REGIONAL BODY FAT AND SERUM TRIGLYCERIDES AND CHOLESTEROL IN HIV-INFECTED CHILDREN

Antiviral Therapy 2000; 5(Suppl. 5):14 (abstract no. O21)

SM Arpadi, PA Cuff, ME Horlick, DP Kotler and J Wang
St Luke's-Roosevelt Hospital Center, Columbia University, New York, NY., USA

BACKGROUND: While changes in regional body fat are often associated with alterations in serum lipids in HIV-infected adults, the association in children has not been established.

OBJECTIVES: To evaluate whether changes in regional fat distribution in HIV-infected children are associated with changes in triglyceride and cholesterol.

DESIGN: A longitudinal, observational study, from February 1994 to December 1999, of 28 HIV-infected pre-pubertal children including 10 boys and 18 girls, aged 4.3-12.2 years. Total and regional body fat (assessed by dual X-ray absorptiometry) and triglyceride and cholesterol were measured at a mean interval of 1.2 years. All except one were receiving treatment with one or more antiretroviral medications at follow-up.

RESULTS: Eight (29%) had abnormal changes in regional fat defined as lipoatrophy of arms and legs together with accumulation of trunk fat (ARF+). Differences in the antiviral medication use were observed between ARF+ and ARF-. Protease inhibitors (PI) were used more commonly in ARF+ children (6/8 versus 6/20, OR=7.0, 95% CI: 1.1-45.2, P=0.044), as was stavudine (6/8 versus 5/20, OR=9.0, 95% CI: 1.4-59.8, P=0.03). There were no statistically significant differences in mean triglyceride and cholesterol between ARF+ and ARF- at baseline, 138±91 versus 105±39, P=0.3 and 127±26 versus 144±38 mg/dl, P=0.3, respectively. Nor were there differences in mean triglyceride and cholesterol at follow-up, 153±78 versus 117±84 mg/dl, P=0.3 and 146±34 versus 146±30 mg/dl, P=1.0, respectively. Changes in triglyceride, however, were significant in ARF+ children during the study (paired t-test, P=0.05). Thirty-eight percent of ARF+ children compared to 0.05% ARF- children experienced a change in triglyceride from <130 to >130 mg/dl during the study (Fisher exact=0.058). Increased triglyceride was associated with PI treatment (OR=3.0 95% CI: 1.7, Fisher exact=0.024) but not other ARV medications, baseline CD4 count <200, or increase in CD4 number or CD4 percentage of >25%.

CONCLUSIONS: Mild increases in triglyceride levels, but not cholesterol, are detectable in children with HIV-infection who experience lipoatrophy of arms and legs together with accumulation of trunk fat. Both triglyceride and abnormal regional fat changes appear to be associated with PI use.

000913
O21

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