(Last updated:February 12, 2014; last reviewed:February 12, 2014)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Lipodystrophy (Fat Maldistribution)
|See below for specific associations.||Onset:
Longer duration of cART
|See below||See below|
|Can occur in the absence of cART, but most associated with PIs and EFV; EFV also associated with gynecomastia and breast hypertrophy||Presentation:
||Obesity before initiation of therapy
||Calorically appropriate low-fat diet and exercise, especially strength training.
Smoking cessation (if applicable) to decrease future CVD risk.
Data are insufficient to allow the Panel to safely recommend use of any of the following modalities in children: recombinant human growth hormone, growth hormone-releasing hormone, metformin, thiazolidinediones, anabolic steroids, or liposuction.
|Facial/Peripheral Lipoatrophy||Most associated with thymidine analogues NRTI (d4T > ZDV)||Presentation:
||d4T and ZDV
Underweight before ART
||Switch from d4T or ZDV to other NRTIs if possible without loss of virologic control.
Data are Insufficient to Allow the Panel to Safely Recommend Use of Any of the Following Modalities in Children:
|Key to Acronyms: ARV = antiretroviral; BMI = body mass index; cART = combination antiretroviral therapy; CVD = cardiovascular disease; d4T = stavudine; DXA = dual energy x-ray absorptiometry; EFV = efavirenz; NRTI = nucleoside reverse transcriptase inhibitor; PI = protease inhibitor; ZDV = zidovudine
See the archived version of Supplement III, February 23, 2009 Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, (http://www.aidsinfo.nih.gov) for a more complete discussion and reference list.