Dislipemia y lipodistrofia en niños uruguayos vih positivos en tratamiento antirretroviral

Stella Gutiérrez; Myriam De León; Leticia Cuñetti; Gabriela Gutiérrez; Verónica Giménez; Jorge Quian

Authors

Stella Gutiérrez Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Pediatría, Prof. Agdo. Policlínica de Seguimiento de Niños VIH-SIDA
Myriam De León Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Nutrición Clínica, Prof. Adj. Licenciado en Nutrición. Policlínica de Seguimiento de Niños VIH-SIDA
Leticia Cuñetti Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Farmacología y Terapéutica, Médico, Asistente. Policlínica de Seguimiento de Niños VIH-SIDA
Gabriela Gutiérrez Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Laboratorio Clínico, Médico, Asistente. Policlínica de Seguimiento de Niños VIH-SIDA
Verónica Giménez Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Licenciado en Nutrición. Policlínica de Seguimiento de Niños VIH-SIDA
Jorge Quian Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Pediatría, Prof. Agdo. Policlínica de Seguimiento de Niños VIH-SIDA

Keywords:

ANTIRETROVIRAL AGENTS, LIPODYSTROPHY, DYSLIPIDEMIAS, HIV INFECTIONS, CHILD

Abstract

Background: Survival of HIV infected patients has improved with Hightly Active Anti-Retroviral Therapy but adverse effects have come out.
Our aim is to describe lipodistrophy and dyslipidemia in HIV infected children under treatment; and to lypodistrophy - dislipidemia/stage of disease - length of treatment.
Methods: The transversal descriptive study defines lipoatrophy as infant with normal body mass index (BMI/IMC) and tricipital skin-fold thickness < 5p or sunken cheeks or both; lipohypertrophy as normal body mass index and subscapular skin-fold > 90p or central fat disposition; combined lipodystrophy when both are present. Hypertriglyceridemia and hypercholesterolemia were defined as > 90p according to tables of reference.
Length of treatment was classified as < 5 years and stage of disease.
Results were expressed as percents, CI 95%. We used the c2 test.
Results: Sixty children aged 6.8 + 3.3 years were included in the study. Lypodystrophy was seen in 13 (21.7%, CI 95% 12.5-34.5) and dyslipidemia in 33 (55%, CI 95% 41.7-67.7). Neither dyslipidemia nor lipodystrophy were associated with stages of the disease. Combined dyslipidemia was predominant in children under at least 5 years of treatment, which was different in cases of hypertrigly-ceridemia. Lipodystrophy was not associated with length of treatment.
Conclusions: Lipodystrophy and dyslipidemia are frequent alterations. Lipid monitoring and body composition are essential to bring up healthier children.

References

1) Leonard EG, McComsey GA. Metabolic complications of antiretroviral therapy in children. Pediatr Infect Dis J 2003; 22: 77-84.
2) Wedekind C, Pugatch D. Lipodystrophy syndrome in children infected with human immunodeficiency virus. Pharmacotherapy 2001; 21(7): 861-6.
3) Friis Moller N, Sabin CA, Weber R, d’Arminio Monforte A, El-Sadr WM, Reiss P, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003; 349(21): 1993-2003.
4) Hernández M, Castellet J, Narvaíza J, Rincón J, Ruiz I, Sánchez E. Curvas y tablas de crecimiento. Madrid: Garzi, 1988.
5) Lhoman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics, 1988.
6) American Academy of Pediatrics. National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992; 89(3 Pt 2): 525-84.
7) Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Recomm Rep 1994; 43(RR-12):1-10.
8) Miller KK, Daly PA, Sentochnik D, Doweiko J, Samore M, Basgoz NO, et al. Pseudo-Cushing’s syndrome in human immunodeficiency virus-infected patients. Clin Infect Dis 1998; 27: 68-72.
9) Jaquet D, Lévine M, Ortega-Rodríguez E, Faye A, Polak M, Vilmer, et al. Clinical and metabolic presentation of the lipodystrophic sindrome in HIV-infected children. AIDS 2000; 14: 2123-8.
10) Arpadi SM, Cuff PA, Horlick MB, Kotler DP, Wang J. Changes in regional body fat and serum triglycerids and cholesterol in HIV infected children. Antivir Ther 2000; 5 (Suppl 5): 14.
11) European Paediatric Lipodystrophy Group. Antiretroviral therapy, fat redistribution and hyperlipidaemia in HIV-infected children in Europe. AIDS 2004; 18(10): 1443-51.
12) Brambilla P, Bricalli D, Sala N, Renzetti F, Manzoni P, Vanzulli A, et al. Highly active antiretroviral-treated HIV-infected children show fat distribution changes even in absence of lipodystrophy. AIDS 2001; 15: 2415-22.
13) Sociedad Uruguaya de Aterosclerosis. Sociedad Uruguaya de Cardiología. 1er. Consenso Nacional de Aterosclerosis, 2004. Recomendaciones para la Prevención y el Tratamiento de la Aterosclerosis. Obtenido de: enbwww.fnr.gub.uy/web2002/noticias/CONSENSO%20.pdf (Consulta: 10 dic 2005)
14) Currier J. Managing metabolic issues and cardiovascular risk in HIV-infected patients. Clinical Care Options; 2005. Obtenido de: http://clinicaloptions.com/hiv/treatment%20updates.aspx (Consulta: 10 dic 2005).
15) Beregszaszi M, Dollfus C, Levine M, Faye A, Deghmoun S, Bellal N, et al. Longitudinal evaluation and risk factors of lipodystrophy and associated metabolic changes in HIV-infected children. J Acquir Immune Defic Syndr 2005; 40(2): 161-8.
16) Farley J, Gona P, Crain M, Cervia J, Oleske J, Seage G, et al. Prevalence of elevated cholesterol and associated risk factors among perinatally HIV- infected children (4-19 years old) in Pediatric AIDS Clinical Trials Group 219C. J Acquir Immune Defic Syndr 2005; 38(4): 480-7.
17) Amaya RA, Kozinetz CA, McMeans A, Schwarzwald H, Kline MW. Lipodystrophy syndrome in human immunodeficiency virus infected children. Pediatr Infect Dis J 2002; 21: 405-10.
18) Grunfeld C, Pang M, Doerrler W, Shigenaga JK, Jensen P, Feingold KR. Lipids, lipoproteins, triglyceride clearance and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endo-crinol Metab 1992; 74(5): 1045-52.
19) Hansson GK, Berne G. Atherosclerosis and the immune system. Acta Pædiatr Suppl 2004; 446: 63-9.
20) Bonnet D, Aggoun Y, Szezepanski I, Bellal N, Blanche S. Arterial stiffness and endothelial dysfunction in HIV-infected children. AIDS 2004; 18(7): 1037-41.
21) Saves M, Chene G, Ducimetiere P, Leport C, Le Moal G, Amouyel P, et al. Risk factors for coronary heart disease in patients treated for human immunodeficiency virus infection compared with the general population. Clin Infect Dis 2003; 37: 292-8.
22) Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, et al. Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation 2004; 109(13): 1603-8.
23) Sharland M, Blanche S, Castelli G, Ramos J, Gibb DM. PENTA guidelines for the use of antiretroviral therapy, 2004. HIV Med 2004; 5 (Suppl 2): 61-86.
24) Nielsen K. Management of Dyslipidemias in HIV-Infected Children on HAART. Obtenido de: http://www.medscape.com/viewarticle/489201 (Consulta: dic 2004).
25) Vacarezza M, Vázquez R, Savio E. Alteraciones del metabolismo lipídico en pacientes infectados por VIH. Rev Méd Urug 2003; 19(1): 45-52.
26) Gutiérrez S, Cuñetti L, De León M, Giménez V, Gutiérrez G, Quian J. Metabolic complications and lipodystrophy in HIV infected children receiving highly active antiretroviral therapy (HAART). (Abstract WePeB5884) International AIDS Conference, 15 (Bangkok, Thailand, 11-16 jul 2004).