Patricia A. Cuff

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

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.

Bone mineral content is lower in prepubertal HIV-infected children.

Summary: Total body bone mineral content (TBBMC) was measured by dual energy x‐ray absorptiometry in a cross‐sectional study of 51 prepubertal HIV‐infected children and 262 healthy prepubertal children aged 4.2 to 14.7 years. The mean TBBMC ± SD was lower in HIV‐positive children than in HIV‐negative controls (955 ± 325 vs. 1,106 ± 273 g, respectively; p = .0006). Reductions in TBBMC remained in the HIV‐positive group after adjusting for age, sex, and race by analysis of covariance (p < .001). Differences in TBBMC between HIV‐positive and HIV‐negative groups persisted when height and weight were also accounted for in the analysis (p = .027). The magnitude of the difference in TBBMC between the groups increased with age. In the HIV‐positive group, no associations were observed between TBBMC and use of a protease inhibitor, duration of treatment with antiretroviral medications, viral load, or CD4 cell count. TBBMC is decreased in HIV‐infected children. As a result of compromised bone mineral accrual, HIV‐infected children may be at increased risk for osteoporosis and related complications.

Application of bioimpedance analysis for estimating body composition in prepubertal children infected with human immunodeficiency virus type 1

The purpose of this study was to evaluate the performance of bioimpedance analysis (BIA) in the prediction of total body water and fat free mass with the use of standard equations in assessing 20 prepubertal children infected with human immunodeficiency virus (HIV). Total body water was measured by means of deuterium oxide dilution, fat free mass by means of total body dual X-ray absorptiometry, and BIA with a bioelectrical impedance analyzer. The use of standard prediction equations resulted in substantial error. Regression equations using height and BIA resistance for estimating total body water and fat free mass were developed and appear to improve accuracy for prediction. This study suggests that total body water and fat free mass can be estimated in children with HIV by means of BIA equations specifically developed for use with this group of children.

Energy balance, viral replication and growth in HIV-infected children|[dagger]| 558

The determinants of growth failure (GF) in pediatric HIV infection are uncertain. We measured dietary intake (DI), resting energy expenditure (REE), total energy expenditure (TEE), and HIV plasma RNA (viral load: VL) in 15 prepubescent HIV+ subjects with and 21 without GF, ages 4-12 years. GF was defined as 12 month growth velocity ≤5th percentile. DI was measured by 3 day food records, REE by indirect calorimetry, TEE by the doubly-labelled water technique, VL by a PCR method (Roche), and fat free mass (FFM) by dual X-ray absorptiometry. The GF+ group was older (p=0.014), had lower CD4+ lymphocyte count, and had higher VL than the GF- group. The GF+ group had lower values for height-for-age (p<0.0001), weight-for-age (p=0.001), and age-adjusted FFM (p=0.0003) than the GF-group. DI was significantly lower in GF+ children, while REE and TEE were similar in the two groups. In conclusion, decreased DI is the most important mediator of GF in HIV+ children. The mechanism underlying decreased DI may be related to viral replication. Abnormalities in REE and TEE do not appear to be factors in HIV-associated GF. Table

Validity of Bioimpedance Analysis(BIA) for Measurement of Body Composition in Prepubescent HIV-Infected Children

Validity of Bioimpedance Analysis(BIA) for Measurement of Body Composition in Prepubescent HIV-Infected Children

Changes in Body Composition in HIV-infected (HIV+) Children with Growth Failure(GF). ♦ 464

In order to assess alterations in body composition in prepubertal children with HIV-associated GF, measurement of body fat (BF) and fat free mass (FFM) by dual energy x-ray absorptiometry; total body water (TBW) and extracellular water (ECW) by D2O and bromide dilution respectively; and body cell mass (BCM) by total body40 K (TBK) counting were performed. Eighteen HIV+ children with GF, 16 HIV+ children with normal growth, and 54 healthy children were studied.Table