Monitoring of lipodystrophic and metabolic abnormalities in HIV-1 infected children on antiretroviral therapy

OBJECTIVE: Few studies have thus far assessed body composition by dual energy X-ray absorptrometry (DXA) in children with HIV, primarily because reference data for normally growing children and adolescents are not available. Our study aimed at evaluating body composition in children with HIV and their relation to serum lipids and glucose homeostasis. DESIGN: Body composition was assessed by DXA in 17 HIV-1 infected children at entrance to the study and after 12 months and in one hundred fifty nine age, gender, body mass index (BMI), and Tanner stage matched healthy subjects who served as controls. Lipodystrophy was diagnosed if the trunk/leg fat ratio was out of the range of the expected mean±1SD of the controls. RESULTS: At study entry, 10 patients (7 girls) had developed lipohypertrophy, whereas all remaining patients had lipoatrophy. Lipohypertrophy was associated with older age (p=0.027). Lipodystrophic phenotype was stable in all patients except in one over the 12-month period of follow-up while on continuous antiretroviral therapy (ART). 80% and 70% of patients with lipohypertrophy had triglycerides and cholesterol levels, respectively above the 75th percentile, while 57% and 43% of patients with lipoatrophy had triglycerides and cholesterol, respectively greater than the 75th percentile. High triglycerides were associated with the use of protease inhibitors (p=0.028). Basal fasting glucose and homeostasis model assessment (HOMA) values were within normal limits. CONCLUSIONS: HIV-infected paediatric patients on continuous ART developed significant and persistent body composition changes which were associated with dyslipidemia without overt abnormalities of glucose metabolism.