Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Management of Medication Toxicity or Intolerance
Lipodystrophy, Lipohypertrophy, Lipoatrophy
Last Updated: April 16, 2019; Last Reviewed: April 16, 2019
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/Monitoring||Management|
|Lipodystrophy (Fat Maldistribution)
|See below for specific associations.||Onset:
||Frequency is low (<5%) with current regimens.||Genetic predisposition
Longer duration of ART
||Physicians should perform a regimen review and consider changing the regimen when lipodystrophy occurs.
Improvement in fat maldistribution following a regimen change is variable. Improvement may occur after several months or years, or it may not occur at all.
|Central Lipohypertrophy or Lipo-accumulation||Can occur in the absence of ART, but these conditions are most often associated with the use of PIs and EFV.||Presentation:
||<5% with current regimens||Obesity before initiation of therapy
||Counsel patient on lifestyle modification and dietary interventions (e.g., maintaining a calorically appropriate, healthy diet that is low in saturated fats and simple carbohydrates, and starting an exercise regimen, especially strength training).
Recommend smoking cessation (if applicable) to decrease future CVD risk.
Consider using an INSTI instead of a PI or EFV.
Data are Insufficient to Allow the Panel to Safely Recommend Use of Any of the Following Modalities in Children:
|Facial/Peripheral Lipoatrophy||Most cases are associated with the use of ZDV, a thymidine analogue NRTI.||Presentation:
||<5% with currently used regimens||Underweight before ART||Prevention:
||Replace ZDV with another NRTI if possible.
Data are Insufficient to Allow the Panel to Safely Recommend Use of Any of the Following Modalities in Children:
|Key to Acronyms: ART = antiretroviral therapy; ARV = antiretroviral; BMI = body mass index; CVD = cardiovascular disease; DXA = dual energy x-ray absorptiometry; EFV = efavirenz; INSTI = integrase strand transfer inhibitor; NRTI = nucleoside reverse transcriptase inhibitor; PI = protease inhibitor; ZDV = zidovudine|
See the archived version of Supplement III, February 23, 2009, Pediatric Guidelines on the AIDSinfo website for a more complete discussion and reference list.
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