Lipodystrophy in HIV-infected pediatric patients receiving protease inhibitors

BACKGROUND: In adults with HIV infection, lipodystrophy syndrome may develop, characterized by peripheral wasting in the extremities, central obesity, hyperlipidemia, and insulin resistance. This syndrome occurs in HIV-positive pediatric patients who take protease inhibitors (PIs). However, the full characteristics of the syndrome in this population is not fully understood. OBJECTIVE: To evaluate the association between the use of PIs and the occurrence of lipodystrophy in HIV-infected children. METHODS: Pediatric patients attending an outpatient HIV clinic between 1994 and 2000 were prospectively enrolled. All patients were between 1 and 17 years of age and had received a PI for at least 1 month. The medical records were reviewed monthly for 3 months before PI therapy was started and then monthly for 36 months. At each evaluation, serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, and blood glucose concentrations were recorded, as well as physician-documented physical examination findings including subcutaneous fat in the arms, face, and legs, and abdominal girth. Baseline clinical and laboratory data were compared with follow-up data using a paired t-test. RESULTS: Twenty-one pediatric patients received a PI. Of these, 2 developed lipodystrophy, one at 15 months and one at 18 months after PI therapy was started. Neither child had had lipodystrophy before therapy. Twelve children who were taking ritonavir or nelfinavir, including 1 who developed lipodystrophy, developed abnormally high total cholesterol and triglyceride blood concentrations. All patients receiving indinavir also experienced a substantial increase in their triglyceride concentrations at follow-up evaluations, but no significant increases in total cholesterol occurred. Blood glucose concentrations were not significantly different between baseline and follow-up examinations in our patients. CONCLUSIONS: Lipodystrophy may occur in some HIV-infected children receiving PIs, and dyslipidemias may also develop in some patients taking these drugs.