Abstract

The lipodystrophy syndrome among HIV infected children in Rio de Janeiro, Brazil

L. Papi¹, R.H. Oliveira², L. Evangelista², T. Abreu², A.C. Frota², C.B. Hofer<sup>3

1</sup>Universidade Federal do Rio de Janeiro, Preventive Medicine, Rio de Janeiro, Brazil, ²Universidade Federal do Rio de Janeiro, Pediatrics, Rio de Janeiro, Brazil, ³Universidade de Federal do Rio de Janeiro, Preventive Medicine - Infectious Diseases, Rio de Janeiro, Brazil

Background: The lipodystrophy syndrome (SLHIV) is an important side effect in patients with HIV/AIDS using antiretrovirals including the pediatric population, however there is scarce data in this specific age group. The aim of this study is to evaluate SLHIV in children and assess possible factors associated with it.
Methods: cross-sectional study aimed to describe lipodystrophy syndrome in Brazilian children with HIV/AIDS, aged 2-15 years old, and to evaluate risk factors associated with it. Patients with SLHIV were defined using the parameters of the European Pediatric Lipodystrophy Group: presence of peripheral lipoatrophy or centripetal lipohypertrophy on physical exam, and may occur in conjunction with laboratory abnormalities of cholesterol and triglycerides). Patients were evaluated using a structured questionnaire; physical exam; and laboratory tests were collected. A bivariate analysis was performed using t-Student or Chi-square tests and multivariate logistic regression was used on the multivariate analysis.
Results: We analyzed 90 children, all in use of HAART. The mean age was 124.2 months, and 44 were boys (48.9%). 48 (53.3%) showed clinical changes consistent with lipodystrophy (31 with lipohypertrophy, 20 with lipoatrophy, and 18 with both). 10 patients showed abnormal cholesterol (and 7 with clinical manifestations), and 17 with abnormal triglycerides (8 with clinical manifestations). Among the risk factors studied, low per capita income (P = 0.065), past use of non-nucleotide reverse transcriptase inhibitors (P = 0.1845), low baseline CD4 (P = 0.0572), inadequate consumption of sugars and fats (P = 0.051), current viral load high (P= 0.0543) were evaluated on the multivariate analysis. The independent risk factor associated with SLHIV was baseline CD4 cells percent (OR=0.94, 95%CI= 0.90-0.99).
Conclusions: More than half of the children fulfilled the SLHIV criteria. Initial CD4 percent was associated with SLHIV, probably immune reconstitution phenomena were associated with this syndrome.