Lipodystrophy in HIV-Infected Children Is Associated With High Viral Load and Low CD4+-Lymphocyte Count and CD4+-Lymphocyte Percentage at Baseline and Use of Protease Inhibitors and Stavudine

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Abstract
Summary:Alterations in regional fat, often associated with abnormalities in lipid and insulin metabolism, have been reported in HIV-infected adults. To determine whether similar abnormalities occur in children with HIV, patterns of change in regional body fat distribution were determined by dual energy x-ray absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) children experienced lipodystrophy (LD), defined as extremity lipoatrophy together with trunk fat accumulation. Despite a mean body weight increase of 2.9 ± 2.4 kg, children with LD experienced a mean loss of total fat in contrast to children without LD who increased total fat (-0.151 ± 0.324 versus 0.981 ± 1.041 kg; p < .01). Children with LD had significantly higher levels of HIV RNA and lower CD4 count and percentage at baseline. LD was associated with use of protease inhibitors or stavudine, (odds ratio [OR], 7.0, 95% confidence interval [CI], 1.1-45.2, p = .04; OR, 9.0, 95% CI, 1.4-59.8, p = .03, respectively). This observational study suggests that during a time in childhood when accumulation of extremity and trunk fat is expected, some HIV-infected children experience changes in fat distribution that are similar to HIV-associated LD reported in adults. Studies to determine whether HIV-infected children with changes in regional fat also experience increases in “atherogenic” lipids and insulin resistance as described in adults with HIV-associated LD are warranted. Address correspondence and reprint requests to Stephen M. Arpadi, St. Luke's Roosevelt Hospital Center Comprehensive HIV Care Center, 1111 Amsterdam Avenue, New York City, NY 10025 U.S.A.; e-mail: [email protected] Manuscript received October 4, 2000; accepted January 26, 2001. © 2001 Lippincott Williams & Wilkins, Inc.