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首页> 外文期刊>BMC Pediatrics >High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy: a cross-sectional study
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High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy: a cross-sectional study

机译：南非青春期前儿童接受抗逆转录病毒治疗的脂肪萎缩患病率高：一项横断面研究

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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.
机译：尽管世卫组织准则有所变化，但在发展中国家，司他夫定仍广泛用于治疗小儿艾滋病毒。撒哈拉以南非洲儿童的脂肪萎缩可能会受到侮辱，并产生深远的影响。居住在撒哈拉以南非洲地区的青春期前儿童脂肪萎缩的严重程度和程度尚不清楚。在这项横断面研究中，从南非的一家家庭艾滋病诊所招募了3-12岁接受抗逆转录病毒治疗和青春期前的儿童。脂肪萎缩症由两名HIV儿科医生通过标准化分级量表达成共识并进行分级。专业的营养师对躯干和四肢脂肪进行了正式的饮食评估和人体测量。记录先前的抗逆转录病毒暴露。在双能X射线吸收法（DXA）中，确定了42名参与者的亚研究体组成。在100名新兵中，视觉上明显的脂肪萎缩的患病率为36％（95％CI：27％–45％）。人体测量学和DXA测量结果证实了脂肪萎缩症的临床诊断：经年龄和性别调整后，两者均证实患有视觉明显脂肪萎缩症的儿童大量，大量肢体脂肪减少。累积暴露于标准剂量司他夫定的每一年，发生脂肪萎缩的调整优势比为1.9（95％CI：1.3-2.9）。标准剂量司他夫定的累积时间与肱二头肌和肱三头肌的皮肤折叠厚度减少显着相关（p = 0.008）。南非青春期前儿童接受抗逆转录病毒治疗的视觉明显脂肪萎缩的患病率很高。儿童需要接触的司他夫定量需要进行评估。需要资源以使中低收入国家能够提供合适的儿科配方替代司他夫定的儿科治疗方案。儿童的标准司他夫定剂量可能需要减少。早期诊断脂肪萎缩对于及时进行抗逆转录病毒切换以阻止疾病进展并避免污名化很重要。使用视觉分级进行诊断需要训练和经验，而DXA和综合人体测量学并不常见。需要一种简单的客观筛查工具，以在缺乏专门技能和设备的资源有限的环境中识别早期脂肪萎缩。

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