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

Alterations in regional fat, often associated with abnormalities in lipid a nd insulin metabolism, have been reported in HIV-infected adults. To determ ine whether similar abnormalities occur in children with HIV, patterns of c hange in regional body fat distribution were determined by dual energy x-ra y absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) child ren experienced lipodystrophy (LD), defined as extremity lipoatrophy togeth er 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 contra st 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 lev els of HIV RNA and lower CD4 count and percentage at baseline. LD was assoc iated 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 ti me in childhood when accumulation of extremity and trunk fat is expected, s ome HIV-infected children experience changes in fat distribution that are s imilar to HIV-associated LD reported in adults. Studies to determine whethe r HIV-infected children with changes in regional fat also experience increa ses in "atherogenic" lipids and insulin resistance as described in adults w ith HIV-associated LD are warranted.