AIDS. 2004 Jul 2;18(10):1443-51. doi: 10.1097/01.aids.0000131334.38172.01.
To estimate prevalence of body fat redistribution and dyslipidaemia in HIV-infected children and to assess associated risk factors, ultimately to inform the definition of lipodystrophy in children.
Cross-sectional observational study.
During a 2-3 month period, 477 HIV-infected children aged >or= 3 years (median 9.78; range, 3-18) in 30 paediatric HIV clinics were assessed at their first visit. Sociodemographic, clinical and immunological data were recorded and the presence or absence of clinical signs of fat redistribution (peripheral lipoatrophy and central lipohypertrophy) determined according to an agreed protocol. Laboratory indicators of lipid/glucose metabolism were recorded for all children in 18 centres.
Prevalence was 26.0% [95% confidence interval (CI), 22.1-30.2] for any fat redistribution, 8.81% (95% CI, 6.42-11.7) for central lipohypertrophy, 7.55% (95% CI, 5.34-10.3) for peripheral lipoatrophy and 9.64% (95% CI, 7.15-12.7) for the combined subtype (more than one sign of each). Independent predictors of fat redistribution included Centers for Disease Control and Prevention class C disease, female gender, ever used versus never use of protease inhibitors and of stavudine. Increasing time since initiation of antiretroviral therapy was associated with increased severity of fat redistribution. In the metabolic assessment subgroup, 27% (95% CI, 21.6-32.7) of children had hypercholesterolaemia and 21% (95% CI, 16.4-26.6) hypertriglyceridaemia; however, significantly more children had fat redistribution in this subgroup than overall (31%).
Approximately a quarter of children and adolescents could be taken to have signs of lipodystrophy, with clinical presentation and risk factors similar to those described in adults.
评估感染人类免疫缺陷病毒(HIV)儿童的体脂重新分布和血脂异常患病率,并评估相关危险因素,最终为儿童脂肪代谢障碍的定义提供依据。
横断面观察性研究。
在2至3个月的时间里,对30家儿科HIV诊所中477名年龄≥3岁(中位数9.78岁;范围3至18岁)的HIV感染儿童进行首次就诊评估。记录社会人口统计学、临床和免疫学数据,并根据商定方案确定是否存在体脂重新分布的临床体征(外周脂肪萎缩和中心性脂肪肥厚)。对18个中心的所有儿童记录脂质/葡萄糖代谢的实验室指标。
任何体脂重新分布的患病率为26.0%[95%置信区间(CI),22.1 - 30.2],中心性脂肪肥厚为8.81%(95%CI,6.42 - 11.7),外周脂肪萎缩为7.55%(95%CI,5.34 - 10.3),联合亚型(每种体征不止一种)为9.64%(95%CI,7.15 - 12.7)。体脂重新分布的独立预测因素包括美国疾病控制与预防中心C类疾病、女性性别、曾经使用过与从未使用过蛋白酶抑制剂以及司他夫定。自开始抗逆转录病毒治疗以来时间的增加与体脂重新分布的严重程度增加相关。在代谢评估亚组中,27%(95%CI,21.6 - 32.7)的儿童有高胆固醇血症,21%(95%CI,16.4 - 26.6)有高甘油三酯血症;然而,该亚组中体脂重新分布的儿童明显多于总体(31%)。
约四分之一的儿童和青少年可能有脂肪代谢障碍的体征,其临床表现和危险因素与成人中描述的相似。