Low prevalence of lipodystrophy in HIV-infected Senegalese children on long-term antiretroviral treatment: the ANRS 12279 MAGGSEN Pediatric Cohort Study.
Low prevalence of lipodystrophy in HIV-infected Senegalese children on long-term antiretroviral treatment: the ANRS 12279 MAGGSEN Pediatric Cohort Study.
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DOI：
10.1186/s12879-018-3282-7
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发表时间：
2018-08-06
影响因子：
3.7
通讯作者：
MAGGSEN Cohort Study Group
中科院分区：
文献类型：
--
作者：
Cames C;Pascal L;Ba A;Mbodj H;Ouattara B;Diallo NF;Msellati P;Mbaye N;Sy Signate H;Blanche S;Diack A;MAGGSEN Cohort Study Group
抗逆转录病毒治疗(ART)的长期益处与代谢并发症有关，特别是脂肪营养不良，在发达国家接受抗逆转录病毒治疗的成年人和儿童中，这种情况已经得到了很好的描述。具体地说，司他夫定，以及较少程度的齐多夫定和蛋白酶抑制剂(PI)，一直被认为与脂肪营养不良的发展有关。2006年，在世界卫生组织的建议下，塞内加尔开始逐步从一线抗逆转录病毒药物中淘汰司他夫定。这项横断面分析的目的是评估和确定参与队列研究的长期服用抗逆转录病毒药物的塞内加尔儿童和青少年中影响脂肪营养不良患病率的危险因素。对接受抗逆转录病毒治疗的2至18岁儿童进行了至少6个月的临床评估，没有并发严重的急性营养不良。采用逐步多变量Logistic回归分析脂营养不良的危险因素。解释变量包括临床和个人数据、免疫病毒学状况和治疗史。总体而言，有254名儿童接受了脂肪营养不良的评估。中位年龄为10.9岁(IQR：8.1-14.2)，接受抗逆转录病毒治疗的中位持续时间为54个月(32-84)。只有18%的人以前接受过司他夫定治疗，中位治疗时间为8个月(5-25个月)。正在进行的治疗包括76%的儿童接受齐多夫定(中位持续时间为48个月(26-74))和27%的儿童接受PI(洛比那韦/利托那韦；中位持续时间为49个月(23-59))。33例(13%)患儿有轻度脂肪营养不良征象，其中脂肪萎缩28例，脂肪肥大4例，混合型1例。男孩比女孩更容易出现脂肪萎缩(AOR：4.3，95%CI：1.6-11.7)。以前接受司他夫定治疗1年的儿童患脂肪萎缩的风险比从未接受治疗的儿童更大(3.81.0-14.0)，尽管这种联系很弱。脂肪营养不良与年龄、当前或累积使用洛匹那韦/利托那韦或齐多夫定的治疗之间没有关联。我们报告了接受长期抗逆转录病毒治疗的儿童和青少年中轻度脂肪营养不良的低患病率，接受非司他夫定的治疗方案。这些发现让低收入环境下的临床医生放心，在那里，齐多夫定被大量开出，而洛匹那韦/利托那韦是唯一广泛使用的PI。ClinicalTrials.gov标识：NCT01771562(注册日期：2013年1月18日)。
The long-term benefits of antiretroviral treatment (ART) are associated with metabolic complications, especially lipodystrophy, which has been well described among HIV-infected adults and children on ART in developed settings. Specifically, stavudine, and to a lesser extent zidovudine and protease inhibitors (PI), have been consistently implicated in the development of lipodystrophy. In 2006, following advice from the WHO, Senegal began phasing out stavudine from first-line ART. The objectives of this cross-sectional analysis are to assess and identify risk factors affecting the prevalence of lipodystrophy in Senegalese children and adolescents on long-term ART participating in a cohort study. Lipodystrophy was clinically assessed in two- to 18-year-old children on ART for at least six months and with no concurrent severe acute malnutrition. Risk factors for lipodystrophy were identified using stepwise multivariable logistic regression. Explanatory variables included clinical and personal data, immunovirologic status, and therapeutic history. Overall, 254 children were assessed for lipodystrophy. The median age was 10.9 years (IQR: 8.1–14.2) and the median duration on ART was 54 months (32–84). Only 18% had been previously treated with stavudine, with a median treatment duration of 8 months (5–25). Ongoing treatment included 76% of children receiving zidovudine (median duration of 48 months (26–74)) and 27% receiving PI (lopinavir/ritonavir; median duration of 49 months (23–59)). Mild signs of lipodystrophy were observed in 33 children (13%): 28 with lipoatrophy, 4 with lipohypertrophy and one with combined type. Boys were more likely to present with lipoatrophy than girls (aOR: 4.3, 95% CI: 1.6–11.7). Children previously treated with stavudine for ≥1 year had a greater risk for lipoatrophy than those never exposed (3.8, 1.0–14.0), although the association was weak. There was no association between lipodystrophy and age or current or cumulative treatment with lopinavir/ritonavir or zidovudine. We report low prevalence of mild lipodystrophy in children and adolescents on long-term ART receiving a stavudine-sparing regimen. These findings are reassuring for clinicians in low-income settings where zidovudine is massively prescribed and lopinavir/ritonavir is the only widely available PI. ClinicalTrials.gov identifier: NCT01771562 (registration date: 01/18/2013).
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