title: Growth velocity, fat-free mass and energy intake are inversely related to viral load in HIV-infected children.
abstract: The study objectives were to assess the relationships among human immunodeficiency virus (HIV) replication, energy balance, body composition and growth in children with HIV-associated growth failure (GF). Energy intake and expenditure, body composition and level of HIV RNA were measured in 16 HIV-infected children with growth failure (HIV+/GF+), defined as a 12-mo height velocity </= 5th percentile for age, and 26 HIV-infected children with normal rates of growth (HIV+/GF-). Energy intake was measured by repeated 24-h dietary recall, resting energy expenditure (REE) by indirect calorimetry and total energy expenditure (TEE) by the doubly labeled water method. Fat-free mass (FFM) was determined by dual X-ray energy absorptiometry and plasma HIV RNA by the polymerase chain reaction method. The mean plasma HIV RNA content among the HIV+/GF+ group was nearly 1.5 log higher than that of the HIV+/GF- group (4. 89 +/- 1.08 vs. 3.43 +/- 1.64 x10(2) copies/L, P: = 0.009). The mean daily energy intake, and age-adjusted REE and TEE were lower in HIV+/GF+ children (P: = 0.003, 0.06 and 0.16, respectively). HIV+/GF+ children had a mean daily energy deficit of 674 +/- 732 kJ/d compared with HIV+/GF- children who had a mean energy surplus of 1448 +/- 515 kJ/d (P: = 0.030). There were no differences in REE after adjustment for differences in FFM and age using multiple regression analysis (P: = 0.88). There was a significant inverse relationship between FFM and plasma HIV RNA [R:(2) = 0.64, standard error of the estimate (SEE) = 3.23] and between viral load and 12-mo growth velocity (R:(2) = 0.61, SE = 1.51). Viral load and energy intake were also inversely related (R(2) = 0.17, SEE = 573.2, P: = 0. 0125). In HIV-infected children, rate of growth, quantity of FFM and energy intake are closely related to the level of HIV replication. The energy intake of children with HIV-associated GF may not be adequate for supporting normal development of FFM and growth, despite possible decreases in total energy expenditure.
authors.affiliation: Department of Pediatrics and HIV Center, Columbia University College of Medicine,and School of Public Health, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Arpadi
authors.forename: P A
authors.initials: PA
authors.lastname: Cuff
authors.forename: D P
authors.initials: DP
authors.lastname: Kotler
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: M
authors.initials: M
authors.lastname: Bamji
authors.forename: M
authors.initials: M
authors.lastname: Lange
authors.forename: R N
authors.initials: RN
authors.lastname: Pierson
authors.forename: D E
authors.initials: DE
authors.lastname: Matthews
mesh_terms: D001823:Body Composition; D001827:Body Height; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D002648:Child; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006128:Growth; D006678:HIV / Q000235:genetics / Q000502:physiology; D015658:HIV Infections / Q000503:physiopathology* / Q000821:virology*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D012044:Regression Analysis; D019562:Viral Load
chemical_list: D012367:RNA, Viral