AEGiS-13IAC: Prevalence of morphologic and serum lipid changes in children and adolescents in use of antiretroviral therapy.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Prevalence of morphologic and serum lipid changes in children and adolescents in use of antiretroviral therapy.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB176)

Rubini NP, Leal DW, Silva EM, Baptista MA, Souza SM, Ribeiro LC, Milczanowski SF, Sion FS, Morais-de-Sb CA
N.P.N. Rubini, University of Rio de Janeiro, Rua Leite Leal, 135 / Bl 1 / Apto. 505, Laranjeiras - Rio de Janeiro - RJ, 22240-100, Brazil, Tel.: +55-21-205 4000, Fax: +55-21-225 2061, E-mail: rubini@montreal.com.br

BACKGROUND: The morphologic and metabolic changes associated with antiretroviral therapy (ART) has been amply investigated in adults. Nonetheless, the same data in children and adolescents are very limited. This study investigated the prevalence of lipodistrophy and serum lipid changes in children and adolescents in use of ART and their relationship with predisposing factors.

METHODS: We analysed retrospectively 66 HIV-infected patients under 18 years of age in use of ART with or without a protease inhibitor (PI) for at least 6 months. The patients were monitored for changes in the distribution of corporal fat and serum levels of cholesterol, triglicerides, HDL and LDL. The frequency of morphologic and serum lipid changes was compared with the following parameters: whether a PI was included in the regimen, how long the ART was used, age, time of active disease, and severity of immunosuppression. Statistical analyses was carried out using the chi-squared test and Fisher's exact test.

RESULTS: Of the 66 patients analysed (38 males), 53 were children and 13 adolescents (average age, 8 é 4.6; median, 8), 37 were in use of double NRTI therapy and 29 with triple therapy consisting of 2 NRTIs and 1 PI, for periods which varied from 6 to 38 months (average, 16.8 é 8.1; median, 16), and with duration of the disease varying between 12 and 192 months (average, 57.2 é 42.9; median, 43). Lipodistrohpy occurred in 5 patients in use of a PI and in 1 patient on double NRTI therapy (p = 0.04). Serum lipid changes were seen in 14 patients in use of a PI and in 20 on double NRTI therapy (p = 0.64). The average levels é SD of the serum lipids (mg/dl) were: cholesterol, 227 é 23; triglycerides, 243 é 92; HDL, 31 é 7; and LDL, 147 é 14. Changes in serum lipids were seen in 26(49%) children and 8 (61%) adolescents (p = 0.41); in 9 (39%) patients using the study regime for 12 months or less and in 25 (58%) using the regime for more than 12 months (p = 0.14); in 10 (34%) patients with symptoms for 3 years or less and in 24 (64%) patients with symptoms for more than 3 years (p = 0.01); and in 14 (50%) patients with severe immunossuppression and 20 (52%) with moderate immunossuppression (p = 0.83).

CONCLUSIONS: Lipid metabolic changes occurred at a high prevalence rate (51%) and with a similar frequency in patients treated with a PI as compared to those not in use of a PI. Patients with a longer disease duration seem to have a larger risk of developing serum lipid changes. Lipodistrophy occurred more frequently in patients taking a PI.

Keywords: AEGIS, Prevalence, HIV Infections, Antiretroviral Therapy, Highly Active, Cholesterol, Triglycerides, Protease Inhibitors, Child, Adolescent, Human, Male, Adolescence, Adult, therapy, utilization, epidemiology, drug therapy
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MoOrB176