Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil.
J Pediatr (Rio J). 2009 Jul-Aug;85(4):329-34. doi: 10.2223/JPED.1910.
To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance.
This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis.
All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80% were on three drugs in combination (highly active therapy) and 30% were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60% of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7%; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance.
The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.
评估获得性免疫缺陷综合征患儿的临床脂肪营养不良，并将其与所采用的抗逆转录病毒方案、血脂谱变化和胰岛素抵抗相关联。
这是一项 2004 年至 2005 年间对 30 名获得性免疫缺陷综合征儿童和青少年（中位数年龄=9.1 岁）进行的横断面研究。进行了以下临床和实验室评估：HIV 感染分类、人体测量（体重和身高）、血清血糖、血清胰岛素和血脂谱（LDL-c、HDL-c、甘油三酯）。使用临床参数诊断脂肪营养不良。采用卡方检验进行统计学分析。
所有患者均定期接受抗逆转录病毒治疗（中位数疗程为 28.4 个月）；80%的患者接受三药联合治疗（高效治疗），30%的患者接受蛋白酶抑制剂治疗。53.3%和 60%的患者分别出现脂肪营养不良和血脂异常。接受高效治疗方案加蛋白酶抑制剂的患儿混合性脂肪营养不良的比例更高；与未接受高效治疗且未接受蛋白酶抑制剂治疗的患儿和未接受高效治疗的患儿相比，差异具有统计学意义（44.4%比 16.7%；p=0.004）。脂肪营养不良的存在与性别、年龄（>10 岁）、血脂谱变化或胰岛素抵抗之间无统计学显著关联。
获得性免疫缺陷综合征患儿血脂异常和脂肪营养不良的发生率升高，与所采用的抗逆转录病毒方案有关，这可能代表未来发生并发症的风险增加，特别是心血管问题。
