High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy : a cross-sectional study

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dc.contributor.authorInnes, Steve
dc.contributor.authorCotton, Mark F.
dc.contributor.authorHaubrich, Richard
dc.contributor.authorConradie, Maria M.
dc.contributor.authorVan Niekerk, Margaret
dc.contributor.authorEdson, Clair
dc.contributor.authorRabie, Helena
dc.contributor.authorJain, Sonia
dc.contributor.authorSun, Xiaoying
dc.contributor.authorZollner, Ekkehard W.
dc.contributor.authorHough, Stephen
dc.contributor.authorBrowne, Sara H.
dc.date.accessioned2013-05-02T07:28:55Z
dc.date.available2013-05-02T07:28:55Z
dc.date.issued2012-11
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.en_ZA
dc.descriptionThe original publication is available at http://www.biomedcentral.com/bmcpediatren_ZA
dc.description.abstractBackground: 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. Methods: 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. Results: 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). Conclusions: 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 resourcelimited settings where specialized skills and equipment are not available.en_ZA
dc.description.sponsorshipStellenbosch University Open Access Funden_ZA
dc.description.versionPublishers' versionen_ZA
dc.format.extent8 p. : ill.
dc.identifier.citationInnes, S. et al. 2012. High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy: a cross-sectional study. BMC Pediatrics, 12:183, doi:10.1186/1471-2431-12-183.en_ZA
dc.identifier.issn1471-2431 (print)
dc.identifier.issn1471-2431 (online)
dc.identifier.otherdoi:10.1186/1471-2431-12-183
dc.identifier.urihttp://hdl.handle.net/10019.1/80712
dc.language.isoen_ZAen_ZA
dc.publisherBioMed Centralen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectLipoatrophy in children -- Africa, Sub-Saharanen_ZA
dc.subjectLipoatrophy in childrenen_ZA
dc.subjectChildren on retroviral therapyen_ZA
dc.subjectHIV-positive children -- Diseases -- Africa, Sub-Saharanen_ZA
dc.titleHigh prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy : a cross-sectional studyen_ZA
dc.typeArticleen_ZA
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