[13] Changes in body fat distribution are detectable in HIV-infected children treated with highly active antiretroviral therapy even in the absence of clinical evidence of lipodystrophy

3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

23-26 October 2001, Athens, Greece

Changes in body fat distribution are detectable in HIV-infected children treated with highly active antiretroviral therapy even in the absence of clinical evidence of lipodystrophy

Antiviral Therapy 2001; 6(Suppl. 4):10 (abstract no. 13)

A Vigano¹, D Bricalle², N Sala², P Manzoni¹, A Vanzulle³, G Chiumello¹, B di Natale² and P Brambilla¹
¹Department of Pediatrics, Scientific Institute HS. Raffaele, University of Milan; ²Chair of Pediatrics, L Sacco Hospital, University of Milan, Italy; and ³Department of Radiology, Ospedale Ca'Granda, Milan, Italy

BACKGROUND: Combined use of dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI) allow a precise estimate of regional body composition and intra-abdominal adipose tissue (IAT).Data on body composition in HIV-infected children on highly active antiretroviral therapy (HAART) with and without lipodystrophy (LD) are lacking.

METHODS: DXA scans were performed in 34 HIV-positive: Six LD-positive, 28 LD-negative and 34 pair-matched (age, sex and body-mass index) healthy controls: six for LD-positive (HC-positive) and 28 for LD-negative (HC-negative). MRI scans were performed in 16 HIV-positive: six LD-positive, 10 LD-negative and 16 pair-matched (age and sex) HC. Data were analysed by ANOVA, post hoc Fisher test and Mann-Whitney test.

RESULTS: LD-positive and LD-negative were similar for: previous exposure to zidovudine/zidovudine plus didanosine, months on HAART (stavudine plus lamivudine plus one protease inhibitor), CD4 cells, patients with HIV RNA <50 copies/ml. In HIV-positive and HC, fat mass and distribution were significantly different, whereas lean mass was comparable. Thus, LD-positive and LD-negative as compared with HC-positive and HC-positive, respectively, showed: (1) reduced fat amount and percentage; (2) lower truncal fat mass; (3) markedly reduced limbs fat mass. Within HIV-positive (4) LD-positive showed higher fat trunk/fat total (P=0.04) and lower fat limbs/fat total ratios (P=0.009) than LD-negative; (5) LD-positive shows larger IAT areas than LD-negative 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 LD. Only LD-positive show true central obesity.

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