Increased lipodystrophy is associated with increased exposure to highly active antiretroviral therapy in HIV-infected children.
OBJECTIVE
To assess body composition changes in HIV-infected children receiving highly active antiretroviral therapy (HAART).


METHODS
Thirty-seven HIV-positive children were enrolled. Dual-energy X-ray absorptiometry (DXA) scans were performed in all HIV-infected children at baseline and after an additional 12 months of HAART and in 54 matched (for sex, age, body mass index [BMI], and pubertal stage) healthy controls. Abdominal MRI was performed in 14 of 37 HIV-positive children at baseline and in 28 of 37 HIV-positive children after additional 12 months of HAART.


RESULTS
During the study period, mean HAART exposure increased from 39.3 to 50.9 months and the number of HIV-infected children with clinical lipodystrophy (LD) increased from 6 to 8, whereas mean BMI, CD4 percentage, and percentage of HIV-infected children with HIV RNA <50 copies/mL did not change. DXA scans showed an increase in lean mass, peripheral fat loss, and central fat accumulation in all HIV-infected children. As compared with controls, 70% and 84% of HIV-infected children showed DXA-detectable LD at baseline and at 12 months of follow-up, respectively. Mixed LD and central fat accumulation were the most common LD phenotype. At baseline and at 12 months of follow-up, intra-abdominal adipose tissue (IAT) was greater than in controls in 33% and 35% of HIV-infected children, and it was greater in those with LD than in those without. Peripheral fat loss and IAT content were associated with duration of HAART and were independent of immunologic stage of disease and immunologic response.


CONCLUSIONS
Changes in body composition related to LD in HAART-treated children are frequent, precocious, and progressive. Duration of HAART negatively influences visceral adiposity and peripheral fat loss.
Viganò
Alessandra
A
Department of Pediatrics, L. Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy. alevig@mailserver.unimi.it
Mora
Stefano
S
Testolin
Corrado
C
Beccio
Sabrina
S
Schneider
Laura
L
Bricalli
Dorella
D
Vanzulli
Angelo
A
Manzoni
Paola
P
Brambilla
Paolo
P
D000005:Abdomen; D015502:Absorptiometry, Photon; D000273:Adipose Tissue; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001823:Body Composition; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000453:epidemiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000009:adverse effects
D011480:Protease Inhibitors