Differences in body circumferences, skin-fold thicknesses and lipid profiles among HIV-infected African children on and not on stavudine

Purpose of the study: To compare body circumferences, skin-fold thickness (SFT) and lipid levels (LL), as measures of lipodystrophy, among antiretroviral therapy (ART)-naive and experienced children at enrolment into the CHAPAS-3 trial. Methods: HIV-infected children in Uganda and Zambia, either ART-naive or on stavudine (d4T) for ≥2years without clinical lipodystrophy, were randomised to receive d4T, abacavir (ABC) or zidovudine (ZDV) with lamivudine and efavirenz (EFV) or nevirapine. At enrolment, mid-upper arm (MUAC) and calf (CC) circumferences, SFT (biceps, triceps, sub-scapular, supra-iliac) and fasting lipids (total cholesterol (TC), low density lipo-protein (LDL), high density lipoprotein (HDL), triglycerides (TRIG)) were measured. Age/sex adjusted z-scores of MUAC, CC, SFT and the sum of SFT (SSF) used Dutch reference data. ART-naive and ART-experienced children were compared with t-tests using Stata v11.0. Summary of results: Among 444 children, 224 (51%) were male and 331 (74.5%) ART-naive. Mean (sd) CD4% was 19.7% (10.2) versus (vs) 34.2% (7.7) in ART-naive vs ART-experienced children. The ART-naive were younger than the ART-experienced children (median [IQR] age 2.5 [1.5, 4.0] vs 6.0 [5.5, 7.0] years, p<0.0001). Among the ART-experienced, 4/108 (3.7%) were on EFV and median (IQR) d4T use was 3.5 (2.7, 4.2) years. As expected, MUAC, CC, weight-for-age (WAZ) and height-for-age (HAZ) z-scores were lower in the ART-naive; the ART-experienced had lower SFT z-scores and higher TC and HDL, but lower TRIG (Table 1). Conclusions: Failure-to-thrive likely contributed to lower circumference values in ART-naive children. Among the ART-experienced, thinner SFT and higher TC values could be ART (particularly d4T)-related. Normal values, currently unavailable for African children, are being collected. During trial follow-up, we will evaluate the effect of ABC, ZDV and d4T on development of lipodystrophy in naive children and its reversibility in d4T-treated children randomised to switch to ZDV/ABC. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Musiime V et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18290 http://www.jiasociety.org/index.php/jias/article/view/18290 | http://dx.doi.org/10.7448/IAS.15.6.18290