Low prevalence of lipodystrophy in HIV-infected Senegalese children on long-term antiretroviral treatment: the ANRS 12279 MAGGSEN Pediatric Cohort Study

Abstract

BackgroundThe 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.MethodsLipodystrophy 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.ResultsOverall, 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.ConclusionsWe 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.Trial registrationClinicalTrials.gov identifier: NCT01771562 (registration date: 01/18/2013).

Improving the informed consent process among HIV‐infected undisclosed minors participating in a biomedical research: insights from the multicentre nutritional SNACS study in Senegal

“…All but one child had been infected through mother‐to‐child transmission and 49% were maternal orphans (Table ). Only 37% had known their HIV status, for a median duration of 11 months . Some groups included both HIV‐disclosed and undisclosed children, and all precautions were taken at every step of the IICP to minimise the risk of accidental disclosure of HIV status to an undisclosed child.…”

“…The SNACS study was an interventional, multicentre research programme designed to assess the effectiveness and acceptability of the WHO guidelines for outpatient nutritional rehabilitation among undernourished HIV‐infected children and adolescents . The study was implemented in Senegal after a report of a high prevalence of HIV‐related wasting among children and adolescents in Dakar . A low HIV disclosure rate, of fewer than 20% of children aged 10–14 years within the routine healthcare system , brought forth a major ethical dilemma of providing research information to mostly HIV‐undisclosed children eligible to participate in a study with objectives directly related to HIV infection.…”

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

“…Some cross‐sectional studies have described stunting among adolescents with HIV. In West and Central Africa, among an ART‐treated population, the prevalence of stunting was 34% among patients aged 10 to 19 years and 42% among patients aged 10 to 16 years in Senegal . In El Salvador, 48% of children with HIV over 12 years of age were stunted .…”

Growth in the first 5 years after antiretroviral therapy initiation among HIV‐infected children in the IeDEA West African Pediatric Cohort

“…Weight and height improve after ART initiation [15], with rapid weight gains in the first months of treatment [16][17][18][19] and linear height gains in the first 2 years of treatment [16][17][18][19][20][21]. However, few studies have been conducted in West Africa [22][23][24], and few beyond 2 years on ART [16,19,24,25].…”