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Boletín Médico del Hospital Infantil de México

2009, Number 4

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Bol Med Hosp Infant Mex 2009; 66 (4)

Fat redistribution and metabolic disturbances in HIV-infected children and adolescents with highly active antiretroviral therapy

Muñoz-Hernández MR, Santos-Preciado JI, Pavía-Ruz N

Language: Spanish
References: 28
Page: 343-349
PDF size: 147.13 Kb.


ABSTRACT

Introduction. Morbidity and mortality associated with human immunodeficiency virus (HIV) infection has decreased since the introduction of highly active antiretroviral therapy. Unfortunately, treatment has been associated with metabolic disorders, lipodystrophy syndrome (LDS) characterized by loss of fat, dyslipidemia and glucose intolerance. This study was conducted in a pediatric outpatient clinic and included children and adolescents infected with HIV/acquired immunodeficiency syndrome (AIDS) aged from 2 to 18 years.
Methods. Total cholesterol, triglycerides and fasting glucose were measured. Patients were evaluated based on characteristics associated with LDS.
Results. Ninety two children and adolescents infected with HIV were included; 51% of patients had hyperlipidemia and 16% showed evidence of fat redistribution. A significant percentage (54%) of HIV-infected children and adolescents developed changes in metabolic parameters or fat redistribution. Hypertriglyceridemia and peripheral lipoatrophy were the most frequent alterations.
Conclusions. Although widely described in adults infected with HIV, reports of LDS in children are rare. Future research lines in children and adolescents infected with HIV/AIDS may determine the therapeutic strategies for the management of LDS in children.


REFERENCES

  1. Selik R, Lindergren ML. Changes in deaths reported with human immunodeficiency virus infection among United States’ children less than thirteen years old, 1987 through 1999. Pediatr Infect Dis J. 2003; 22: 635-41.

  2. Bitnum A. Serum lipids, glucose homeostasis and abdominal adipose tissue distribution in protease inhibitor-treated and naïve HIV-infected children. AIDS. 2003; 17: 1319-27.

  3. Nuñez-Cuadros E, Mellado-Peña MJ, Rivera-Cuello M, Cenim-Fernández M, Piñeiro-Pérez R, García-Hortelano M, et al. Toxicidad de fármacos antirretrovirales en niños infectados por el virus de la inmunodeficiencia humana. An Pediatr (Barc). 2008; 68: 425-31.

  4. Leonard E, McComsey G. Metabolic complications of antiretroviral therapy in children. Pediatr Infect Dis J. 2003; 22: 77-84.

  5. Piliero P, Gianoukakis A. Ritonavir-associated hyperparathyroidism, osteopenia and bone pain. AIDS. 2002; 16: 1565-6.

  6. Wedekind C, Pugatch D. Lipodystrophy syndrome in children infected with human immunodeficiency virus. Pharmacotherapy. 2001; 21; 861-6.

  7. Sánchez-Torres AM, Muñoz-Muñíz R, Madero R, Borque C, García MJ, de José-Gómez MI. Prevalence of fat redistribution and metabolic disorders in human immunodeficiency virus-infected children. Eur J Pediatr. 2005; 164: 271-6.

  8. Behrens GM, Stoll M, Schmidt RE. Lipodystrophy syndrome in HIV infection: what it, what causes it and how can it be managed? Drug Saf. 2000; 23: 57-76.

  9. Kulasekaram R, Peters BS, Wierzbicki A. Dyslipidaemia and cardiovascular risk in HIV infection. Curr Med Res Opin. 2005; 21: 1717-25.

  10. Triodras S, Mantzoros C, Hammer S, Samore M. Effects of protease inhibitors on hyperglycemia, hiperlipidemia and lipodystrophy: a 5-years cohort study. Arch Intern Med. 2000; 160: 2050-56.

  11. Saves M, Raffi F, Capeau J, et al. Factors related to lipodystrophy and metabolic alterations in patients with human immunodeficiency virus infection receiving highly active antiretroviral therapy. Clin Infect Dis. 2002; 34: 1396-405.

  12. National Institutes of Health. National Cholesterol Education Program, ATP III Guidelines At-A-Galance Quick Desk Reference. Bethesda, MD National Heart, Lung and Blood Institute; 2001.

  13. Jaquet D, Levine M, Ortega-Rodríguez E. Clinical and metabolic presentation of the lipodystrophic syndrome in HIV-infected children. AIDS. 2000; 14: 2123-8.

  14. Solórzano-Santos F, Goicochoa-Rangel L, Palacios-Saucedo G, Vázquez-Rosales G, Miranda-Novales G. Hypertriglyceridemia and hypercholesterolemia in human immunodeficiency virus-1- infected children treated with protease inhibitors. Arch Med Res. 2006; 37: 129-32.

  15. Aurpibul L, Puthanakit T, Lee B, Mangklabruks A, Sirisanthana T, Sirisanthana V. Lipodystrophy and metabolic changes in HIV infected children on non nucleoside reverse transcriptase inhibitor based antiretroviral therapy. Antivir Ther. 2007; 12: 1247-54.

  16. Polo AR, Galindo BMJ, Martínez CE, Álvarez DJ, Recomendaciones de GEAM/SPNS sobre el tratamiento de las alteraciones metabólicas y morfológicas en el paciente con infección por VIH. Enferm Infecc Microbiol Clin. 2006; 24: 96-117.

  17. Amaya R, Kozinetz C, McMeans A, Kline M. Lipodystrophy syndrome in human immunodeficiency virus-infected children. Pediatr Infect Dis J. 2002; 21: 405-10.

  18. Farley J, Gona P, Crain M, Cervia J. Prevalence of hypercholesterolemia and associated risk factors among perinatally HIV-infected children (4-19 years) in PACTG 219C. 10th Conference of Retroviruses and Opportunistic Infections. Abstract 773. Boston, MA, USA: 2003.

  19. Cursi L, Fodo L, Cancrini C, et al. Evaluation of lipodystrophy in children and adolescent treated with HAART. Abstract TuPeB4523. XIV International AIDS Conference. Barcelona, Spain: July 7-12; 2002.

  20. Lainka A, Oezbek S, Falck M, et al. Marked dyslipidemia in human-immunodeficiency virus-infected children on protease inhibitor-containing antiretroviral therapy. Pediatrics. 2002; 110: 998-9.

  21. Meneilly G, Forbes J, Peabody D, et al. Metabolic and body composition changes in HIV-infected children on antiretroviral therapy. Abstract 650. En: Eighth Conference on Retroviruses and Opportunistic Infections. Chicago: Foundation for Retrovirology and Human Health; February 4 to 8; 2001.

  22. Mellado MJ, Villota J, García M. Lipodystrophy syndrome in HIV-infected children. Abstract TuPeB4635. XIV International AIDS Conference. Barcelona, Spain: July 7-12; 2002.

  23. Bockhorst J, Ksseiry I, Toye M, et al. Evidence of human immunodeficiency virus-associated lipodystrophy syndrome in children treated with protease inhibitors. Pediatr Infect Dis J. 2003; 22: 463-5.

  24. European Paediatric Lipodystrophy Group. Antiretroviral therapy, fat redistribution and hyperlipidaemia in HIV-infected children in Europe. AIDS. 2004: 18: 1443-51.

  25. Guidelines for the use of antiretroviral agents in pediatric HIV infection. 2008 February. Available from: http://aidsinfo.nih.gov/contentfiles/PediatricGL_SupIII.pdf

  26. Hansen BR, Haugaard SB, Iversen J, et al. Impact of switching antiretroviral therapy on lipodystrophy and other metabolic complications: A review. Scand J Infect Dis. 2004; 36: 244-53.

  27. Martínez E, Arnaiz JA, Podzamczer D, et al. Substitution of nevirapine, efavirenz, or abacavir for protease inhibitors in patients with human immunodeficiency virus infection. N Engl J Med. 2003; 349: 1036-46.

  28. Kamin D, Hadigan C. Hyperlipidemia in children with HIV infection: an emerging problem. Expert Rev Cardiovasc Ther. 2003; 1: 143-50.




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