Musiime Victor, Cook Adrian, Kayiwa Joshua, Zangata Dorothy, Nansubuga Carol, Arach Beatrice, Kenny Julia, Wavamunno Priscilla, Komunyena Justine, Kabamba Desiree, Asiimwe Alice R, Mirembe Grace, Abongomera George, Mulenga Veronica, Kekitiinwa Adeodata, Kityo Cissy, Walker Sarah A, Klein Nigel, Gibb Diana M
Joint Clinical Research Centre, Kampala, Uganda.
Antivir Ther. 2014;19(3):269-76. doi: 10.3851/IMP2695. Epub 2013 Oct 25.
Few studies have investigated objective markers of lipodystrophy in African children. We compared body circumferences, skin-fold thickness (SFT) and lipids in antiretroviral therapy (ART)-naive and stavudine (d4T)-exposed children with HIV-uninfected controls.
In the CHAPAS-3 trial, HIV-infected children (ART-naive or on d4T for ≥2 years without clinical lipodystrophy) were randomized to d4T, abacavir or zidovudine with lamivudine (3TC) plus a non-nucleoside reverse transcriptase inhibitor. Mid-upper-arm circumference (MUAC) and calf circumference (CC), SFT (biceps, triceps, sub-scapular and supra-iliac) and fasting lipids (total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL] and triglycerides [TRIG]) were measured at randomization in all HIV-infected children, and in HIV-uninfected controls. Age- and sex-adjusted z-scores of MUAC, CC, SFT and the sum of SFT (SSF) using Dutch reference data were compared across groups using linear regression.
Of 496 children, 49% were male, 299 (median age 2.5 years [IQR 1.5-4.0]) were ART-naive, 109 (median age 6 years [IQR 5.5-7.0]) were ART-experienced and 88 (median age 2.2 years [IQR 1.5-3.0]) were control children. Overall, 100% and 95% of ART-experienced children had been on d4T plus 3TC and nevirapine, respectively, for a median 3.5 years (IQR 2.6-4.2). Mean (sd) weight-for-age z-scores and MUAC z-scores were -1.51 (1.29) versus -0.90 (0.88) versus -0.33 (1.15) and -1.56 (1.25) versus -1.24 (0.97) versus -0.65 (1.06) in ART-naive versus -experienced versus controls, respectively (all P<0.02). The mean (sd) of SSF was lower in the ART-experienced (-0.78 [1.28]) than in the ART-naive (-0.32 [1.09]; P<0.0001) children and controls (-0.29 [0.88]; P<0.002). ART-experienced children had higher mean fasting TC, LDL and HDL but lower TRIG compared to ART-naive children (P-values <0.0001), and higher TC and HDL but lower TRIG compared to controls (P-values <0.01).
In ART-experienced children on d4T-containing regimens, we observed lower SFT and higher TC and LDL values compared to ART-naive children and HIV-uninfected controls.
很少有研究调查非洲儿童脂肪营养不良的客观标志物。我们比较了未接受抗逆转录病毒治疗（ART）和暴露于司他夫定（d4T）的HIV感染儿童与未感染HIV的对照儿童的体围、皮褶厚度（SFT）和血脂情况。
在CHAPAS-3试验中，将HIV感染儿童（未接受ART或接受d4T治疗≥2年且无临床脂肪营养不良）随机分为接受d4T、阿巴卡韦或齐多夫定联合拉米夫定（3TC）加一种非核苷类逆转录酶抑制剂治疗组。在所有HIV感染儿童及未感染HIV的对照儿童随机分组时，测量其上臂中部周长（MUAC）和小腿周长（CC）、SFT（肱二头肌、肱三头肌、肩胛下和髂嵴上）以及空腹血脂（总胆固醇[TC]、低密度脂蛋白[LDL]、高密度脂蛋白[HDL]和甘油三酯[TRIG]）。使用荷兰参考数据，通过线性回归比较各年龄和性别调整后的MUAC、CC、SFT及SFT总和（SSF）的z评分。
496名儿童中，49%为男性，299名（中位年龄2.5岁[四分位间距1.5 - 4.0]）未接受ART治疗，109名（中位年龄6岁[四分位间距5.5 - 7.0]）接受过ART治疗，88名（中位年龄2.2岁[四分位间距1.5 - 3.0]）为对照儿童。总体而言，100%接受过ART治疗的儿童曾接受d4T加3TC治疗，95%接受过奈韦拉平治疗，中位治疗时间为3.5年（四分位间距2.6 - 4.2）。未接受ART治疗组、接受过ART治疗组和对照组儿童的年龄别体重z评分均值（标准差）分别为-1.51（1.29）、-0.90（0.88）和-0.33（1.15），MUAC z评分分别为-1.56（1.25）、-1.24（0.97）和-0.65（1.06）（所有P<0.02）。接受过ART治疗的儿童的SSF均值（标准差）（-0.78[1.28]）低于未接受ART治疗的儿童（-0.32[1.09]；P<0.0001）和对照组儿童（-0.29[0.88]；P<0.002）。与未接受ART治疗的儿童相比，接受过ART治疗的儿童空腹TC、LDL和HDL均值较高，但TRIG较低（P值<0.0001）；与对照组相比，接受过ART治疗的儿童TC和HDL较高，但TRIG较低（P值<0.01）。
在接受含d4T方案治疗的有ART治疗史的儿童中，与未接受ART治疗的儿童及未感染HIV的对照儿童相比，我们观察到其SFT较低，TC和LDL值较高。
