Department of Pediatrics, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
Indian J Pediatr. 2009 Oct;76(10):1017-21. doi: 10.1007/s12098-009-0216-9. Epub 2009 Nov 12.
To assess the metabolic drug toxicities of first-line, World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens, to estimate the prevalence of body fat redistribution and to identify associated risk factors.
Cross-sectional observational study. During 3 month period, 52 HIV infected children (25 on HAART; 27 not on HAART) were assessed. Their sociodemographic, clinical, and immunological data was recorded. Children were examined or the signs of fat redistribution (peripheral lipoatrophy and central lipohypertrophy). Liver function tests, fasting blood sugar, lipid profile, serum amylase, serum lactate, blood pH and bicarbonate levels were done in all patients.
Twenty-two patients were on stavudine and three on zidovudine based HAART. None of the patients ever received any protease inhibitor. There were no cases of clinical or immunological failure. Children on HAART had significantly lower weight for age and body mass index but the mean height for age was similar between study groups. Only two cases of peripheral lipoatrophy were observed. Hypercholesterolemia was observed in four children on HAART but none without therapy. Hypertriglyceridemia was observed in three children on HAART and seven without therapy. Four cases of asymptomatic mild hyperlactatemia were observed. No case of any hyperglycemia or liver impairment was observed.
Metabolic abnormalities and lipodystrophy are emerging complications of HAART in Indian children and needs very close follow up. Future studies with larger sample size and longitudinal model are recommended.
评估世界卫生组织（WHO）推荐的一线通用高效抗逆转录病毒治疗（HAART）方案的代谢性药物毒性，估计体脂重新分布的发生率，并确定相关的危险因素。
横断面观察性研究。在 3 个月的时间内，评估了 52 名 HIV 感染儿童（25 名接受 HAART；27 名未接受 HAART）。记录了他们的社会人口学、临床和免疫数据。对儿童进行了脂肪重新分布（外周脂肪萎缩和中心脂肪肥大）的体征检查。对所有患者进行了肝功能检查、空腹血糖、血脂谱、血清淀粉酶、血清乳酸、血 pH 值和碳酸氢盐水平检查。
22 名患者接受了司他夫定和 3 名患者接受了齐多夫定为基础的 HAART。没有患者曾经接受过任何蛋白酶抑制剂。没有临床或免疫失败的病例。接受 HAART 的儿童体重和体重指数明显较低，但两组的平均身高年龄相似。仅观察到 2 例外周脂肪萎缩。在接受 HAART 的 4 名儿童中观察到高胆固醇血症，但无治疗组无此现象。在接受 HAART 的 3 名儿童和未接受治疗的 7 名儿童中观察到高三酰甘油血症。观察到 4 例无症状轻度高乳酸血症。未观察到任何高血糖或肝损伤的病例。
代谢异常和脂肪营养不良是印度儿童接受 HAART 后的新兴并发症，需要密切随访。建议进行未来的研究，样本量更大，并采用纵向模型。
