Dapena Marta, Jiménez Beatriz, Noguera-Julian Antoni, Soler-Palacín Pere, Fortuny Clàudia, Lahoz Rebeca, Aracil Francisco Javier, Figueras Concepción, de José María Isabel
Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron -- Universitat Autònoma de Barcelona, Barcelona, Spain.
J Pediatr Endocrinol Metab. 2012;25(5-6):529-35. doi: 10.1515/jpem-2012-0005.
Despite metabolic disorders in HIV-infected children being widely described, there is still a lack of agreed criteria for diagnoses and management. Numerous studies are coming from other settings and results are heterogeneous when assessing several analytical and clinical parameters.
To describe the prevalence of metabolic disorders and associated risk factors in the Spanish National cohort of HIV-infected pediatric patients (CoRISpe).
This was a cross-sectional study following all vertically HIV-infected children and adolescents in three referral centers included in the CoRISpe. Metabolic data (fasting lipids, glucose and insulin levels and thyroid hormone levels) were collected. Fat distribution was clinically assessed by expert clinicians.
We included 157 patients [median age 13 years, interquartile range (IQR) 10-16]. Median duration of antiretroviral therapy was 10.2 years (IQR 5.0-13.0). Almost 20% of patients had insulin resistance and this was associated with hepatitis C co-infection, current use of stavudine (d4T) and hypertriglyceridemia. Hypercholesterolemia and hypertriglyceridemia were found in 23.9% and 24.8% of patients and were associated with current use of protease inhibitors (p = 0.042 and p = 0.022, respectively). Abnormal fat distribution was observed in 63 patients (40.5%): lipoatrophy in 32 (20.4%), lipohypertrophy in eight (5.1%) and a mixed pattern in 23 patients (14.6%), and it was significantly associated with previous exposure to stavudine (p < 0.001).
Metabolic disorders are a significant problem in our HIV-infected pediatric population. We need to encourage the development of global strategies and the creation of consensus guidelines that can decrease the cardiovascular risk in this population.
尽管已对感染HIV儿童的代谢紊乱进行了广泛描述，但在诊断和管理方面仍缺乏一致的标准。众多研究来自其他地区，在评估多个分析和临床参数时结果存在异质性。
描述西班牙全国感染HIV的儿科患者队列（CoRISpe）中代谢紊乱的患病率及相关危险因素。
这是一项横断面研究，对CoRISpe纳入的三个转诊中心的所有垂直感染HIV的儿童和青少年进行研究。收集代谢数据（空腹血脂、血糖和胰岛素水平以及甲状腺激素水平）。由专业临床医生对脂肪分布进行临床评估。
我们纳入了157例患者[中位年龄13岁，四分位间距（IQR）为10 - 16岁]。抗逆转录病毒治疗的中位时长为10.2年（IQR为5.0 - 13.0）。近20%的患者存在胰岛素抵抗，这与丙型肝炎合并感染、当前使用司他夫定（d4T）和高甘油三酯血症有关。23.9%和24.8%的患者分别出现高胆固醇血症和高甘油三酯血症，且与当前使用蛋白酶抑制剂有关（分别为p = 0.042和p = 0.022）。63例患者（40.5%）出现脂肪分布异常：32例（20.4%）为脂肪萎缩，8例（5.1%）为脂肪增生，23例患者（14.6%）为混合模式，且与既往使用司他夫定显著相关（p < 0.001）。
代谢紊乱在我们感染HIV的儿科人群中是一个重大问题。我们需要鼓励制定全球策略并创建共识性指南，以降低该人群的心血管风险。
