Highly active antiretroviral-treated HIV-infected children show fat distribution changes even in absence of lipodystrophy.

Background: Combined use of dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI) allows a precise estimate of regional body composition and intra-abdominal adipose tissue (IAT). Data on body composition in HIV-infected children (HIV+) receiving highly active antiretroviral therapy (HAART) with (LD+) and with (LD-) lipodystrophy are lacking. Methods: DXA scans were performed in 34 HIV+: six LD+ 28 LD- and 34 pair-matched (age sex and body mass index) healthy controls (HC): six for LD+ (HC+) and 28 for LD- (HC-). MRI scans were performed in 16 HIV+: six LD+ 10 LD- and 16 pair-matched (age and sex) HC. Data were analysed by analysis of variance post hoc Fisher test and Mann-Whitney test. Results: LD+ and LD- were similar for: previous exposure to zidovudine/zidovudine + didanosine months on HAART (stavudine + lamuvidine + one protease inhibitor) CD4+ cells patients with HIV-RNA < 50 copies/ml. In HIV+ and HC fat mass and distribution were significantly different whereas lean mass was comparable. Thus LD+ and LD- as compared to HC+ and HC- respectively showed: 1. reduced fat amount and percentage; 2. lower truncal fat mass; 3. markedly reduced limbs fat mass. Within the HIV+ group 4. LD+ showed higher fat trunk/fat total (P = 0.04) and lower fat limbs/fat total ratios (P = 0.009) than LD-; 5. LD+ showed larger IAT areas than LD- and HC (P < 0.0003). Conclusions: Increased central fat and peripheral lipoatrophy are distinctive features of all HAART-treated children. Changes in body fat composition are detectable by DXA even in the absence of signs of Lipodystrophy. Only LD+ show true central obesity. (authors)