Body Composition Changes and Predictors of Lipodystrophy in a Cohort of Pre-pubertal HIV- infected Children
Cecília Zanin Palchetti
Division of Nutrology, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04040-032, São Paulo, SP, Brazil.
Regina Célia de Menezes Succi
Division of Pediatric Infectious Diseases, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04040-003 São Paulo, SP, Brazil
Vera Lúcia Szejnfeld
Division of Rheumatology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04023-900, São Paulo, Brazil.
Patrícia Fonseca Teixeira
Division of Nutrology, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04040-032, São Paulo, SP, Brazil.
Rose Vega Patin
Division of Nutrology, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04040-032, São Paulo, SP, Brazil.
Aída de Fátima Thomé Barbosa
Division of Pediatric Infectious Diseases, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04040-003 São Paulo, SP, Brazil.
Fernanda Luisa Ceragioli Oliveira *
Division of Nutrology, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/EPM), 04040-032, São Paulo, SP, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Aim: To evaluate body composition changes in HIV-infected patients and to identify the predictors of lipodystrophy over time.
Methods: A cohort study, evaluated over two and a half years (Time 1: T1; Time 2: T2), including prepubertal HIV-infected children of both genders, between 7-12 years of age. Patient’s data such as transmission, use of prophylaxis for vertical HIV transmission, clinical and immunological classification of disease and current antiretroviral therapy were derived from the medical records. At T1, only subjects with pubertal stage 1 were included. Clinical, anthropometric, body composition and biochemical data were assessed. Patients were divided into two groups: with (LD+) and without lipodystrophy (LD-).
Results: A total of 40 patients were enrolled, and 35 patients completed the study. Mean (SD) age was 9.6 (1.1) and 11.6 (1.2) years at T1 and T2, respectively. At T2, 16 (45.7%) children remained prepubertal. LD+ group (n = 8) showed a higher prevalence of short stature (p = 0.008) in T1; higher insulin (p = 0.010) and HOMA-IR (p = 0.013) and reduction of triceps skinfold thickness (p = 0.026) at T2. In both times, we observed lower concentrations of HDLc (p = 0.027), higher values of trunk to arm ratio (p = 0.002, p = 0.001) and lower values of limb to trunk ratio (p = 0.001) and gynoid fat (p= 0.001) in LD+ group. At T1, predictors of lipodystrophy were short stature (OR = 46.198, p = 0.019) and limb to trunk ratio (OR = 0.00009, p = 0.011); in T2, waist circumference (OR = 1.199, p = 0.025) and HDLc (OR = 0.835, p = 0.015). Presence of lipodystrophy was determinant of high insulin levels at T2.
Conclusion: In a short period, LD+ group had significant changes in body fat distribution and also biochemical alterations associated to lipodystrophy syndrome.
Keywords: HIV, child, body composition, lipodystrophy