Highly active antiretroviral-treated HIV-infected children show fat distribution changes even in absence of lipodystrophy
Brambilla, P.; Bricalli, D.; Sala, N.; Renzetti, F.; Manzoni, P.; Vanzulli, A.; Chiumello, G.; di Natale, B.; Viganò, A.
Aids 15(18): 2415-2422
2001
ISSN/ISBN: 0269-9370 PMID: 11740192 DOI: 10.1097/00002030-200112070-00009Document Number: 260959
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 human immunodeficiency virus-infected children (HIV+) receiving highly active antiretroviral therapy (HAART) with (LD+) and without (LD-) lipodystrophy are lacking. DXA scans were performed in 34 HIV+: six LD+, 28 LD- and 34 pair-matched (age, sex and body mass index) healthy controls (HC): 6 for LD+ (HC+) and 28 for LD- (HC-). MRI scans were performed in 16 HIV+: 6 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. LD+ and LD- were similar for: previous exposure to zidovudine/zidovudine+didanosine, months on HAART (stavudine+lamivudine+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). 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.