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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy: A cross-sectional study
BMC Pediatrics, Volume 12, Article 183, Year 2012
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Description
Despite changes in WHO guidelines, stavudine is still used extensively for treatment of pediatric HIV in the developing world. Lipoatrophy in sub-Saharan African children can be stigmatizing and have far-reaching consequences. The severity and extent of lipoatrophy in pre-pubertal children living in sub-Saharan Africa is unknown.In this cross-sectional study, children who were 3-12 years old, on antiretroviral therapy and pre-pubertal were recruited from a Family HIV Clinic in South Africa. Lipoatrophy was identified and graded by consensus between two HIV pediatricians using a standardized grading scale. A professional dietician performed formal dietary assessment and anthropometric measurements of trunk and limb fat. Previous antiretroviral exposures were recorded. In a Dual-Energy X-ray Absorbtiometry (DXA) substudy body composition was determined in 42 participants.Among 100 recruits, the prevalence of visually obvious lipoatrophy was 36% (95% CI: 27%-45%). Anthropometry and DXA measurements corroborated the clinical diagnosis of lipoatrophy: Both confirmed significant, substantial extremity fat loss in children with visually obvious lipoatrophy, when adjusted for age and sex. Adjusted odds ratio for developing lipoatrophy was 1.9 (95% CI: 1.3 - 2.9) for each additional year of accumulated exposure to standard dose stavudine. Cumulative time on standard dose stavudine was significantly associated with reductions in biceps and triceps skin-fold thickness (p=0.008).The prevalence of visually obvious lipoatrophy in pre-pubertal South African children on antiretroviral therapy is high. The amount of stavudine that children are exposed to needs review. Resources are needed to enable low-and-middle-income countries to provide suitable pediatric-formulated alternatives to stavudine-based pediatric regimens. The standard stavudine dose for children may need to be reduced. Diagnosis of lipoatrophy at an early stage is important to allow timeous antiretroviral switching to arrest progression and avoid stigmatization. Diagnosis using visual grading requires training and experience, and DXA and comprehensive anthropometry are not commonly available. A simple objective screening tool is needed to identify early lipoatrophy in resource-limited settings where specialized skills and equipment are not available. © 2012 Innes et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Innes, Steve
South Africa, Tygerberg
Tygerberg Hospital
Cotton, Mark Fredric
South Africa, Tygerberg
Tygerberg Hospital
Haubrich, Richard H.
United States, La Jolla
University of California, San Diego
Conradie, Maria Martha
South Africa, Stellenbosch
Stellenbosch University
van Niekerk, Margaret
South Africa, Stellenbosch
Stellenbosch University
Edson, Clair
South Africa, Stellenbosch
Stellenbosch University
Rabie, Helena
South Africa, Stellenbosch
Stellenbosch University
Jain, Sonia O.
United States, La Jolla
University of California, San Diego
Sun, Xiaoying
United States, La Jolla
University of California, San Diego
Zöllner, Ekkehard Werner A.
South Africa, Stellenbosch
Stellenbosch University
Hough, Stephen F.
South Africa, Stellenbosch
Stellenbosch University
Browne, Sara Hope
United States, La Jolla
University of California, San Diego
Statistics
Citations: 27
Authors: 12
Affiliations: 3
Identifiers
Doi:
10.1186/1471-2431-12-183
e-ISSN:
14712431
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Case-Control Study
Study Approach
Quantitative
Study Locations
South Africa