Detection of lipoatrophy in human immunodeficiency virus-1-infected children treated with highly active antiretroviral therapy

Background: Highly active antiretroviral therapy has been associated with lipodystrophy in adults. Much is unknown about its characteristics, especially in children. Objective: To obtain an objective case definition of the lipodystrophy syndrome. Methods: This was a cross-sectional study. One investigator rated clinical lipodystrophy. Body composition was measured using body mass index, skin fold thickness and circumference of arm, leg, waist and hip. Samples for human immunodeficiency virus (HIV)-1 RNA, CD4 cell count, fasting lipids and glucose variables were drawn. HIV-infected children with lipodystrophy were compared with HIV-infected children without lipodystrophy (controls). Results: Thirty-four children were included: 28 controls, 2 nonassigned, and 4 with the lipoatrophic phenotype. Lipohypertrophy or mixed syndrome were not observed. All children with lipoatrophy were pubertal; they had used stavudine and didanosine longer. Children with lipoatrophy had significantly smaller arm and leg circumference, and their skin folds were thinner. The torso-to-arm ratio was 3 times higher in lipoatrophic children, but the difference did not reach significance. The waist-to-hip ratio was higher (P = 0.005). None of the laboratory values differed significantly between the two groups, but all children with lipoatrophy had an increased C-peptide level above the upper limit of normal. All children with lipoatrophy could be distinguised from controls by an increased C-peptide level, a waist-to-hip ratio z score of 1 standard deviation or higher and a sum of skin folds z score below -1 standard deviation. Conclusions: All children with lipoatrophy can be distinguished by using anthropmetric measurements and C-peptide measurement in serum. This method is simple, readily available and inexpensive.