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Changes in Regional Fat Distribution in HIV-Infected Children S. ARPADI*, P. CUFF, D. KOTLER, M. HORLICK, J. WANG, and S. HESHKA.
St. Luke's–Roosevelt Hosp. Ctr.; and Columbia Univ., New York, NY The objective of this study was to evaluate changes in regional fat distribution in HIV-infected children using objective criteria and to evaluate associated risk factors.
Methods: Changes in regional fat measurements ascertained by repeat dual x-ray absorptiometry (DXA) performed during 1994-9 in 32 HIV-infected children ages 4.3-14.9 yrs, including 14 boys and 18 girls were assessed. Characteristics of children with changes in regional fat (RFC+), defined as an increase in truncal fat together with a decrease in appendicular fat (arm fat + leg fat), and those without these changes (RFC-) were compared at baseline and follow-up.
Results: Nine (28%) children were RFC+. There were no differences in age, height, weight, weight-for-height percentiles, total body fat percent, or distribution of race, sex, or stage of sexual maturation at baseline compared with RFC-. The interval between DXA scans and length of time on PI-containing regimens were similar in the RFC+ and RFC- children (1.20+.63 vs 1.18+.44 yrs, p=0.91 and .93+.62 vs 1.01+.64 yrs, p=0.82, respectively). RFC+ children had significantly lower mean CD4 number at baseline (167+198 vs 653+ 438 cells/dL, p=0.002) and at follow up (403+208 vs 700+443 cells/dL, p=0.03) compared to RFC- children. An increase in CD4 count of >25% was associated with RFC (OR=10.0, 95%CI=0.8-119.3, Fisher's Exact Test =0.043). Six out of 9 RFC+ children began PI-containing regimens compared to 9 out of 23 RFC- children in the interval between DXA scans. Changing to a PI-containing regimen was not significantly associated with RFC (OR=3.1, 95%CI=0.6-15.9, Fisher's Exact Test =0.24). RFC+ children received 7 distinct treatment combinations involving 9 medications including: 5 NRTIs, 3PIs, and 1 NNRTI.
Conclusions: A pattern of regional fat distribution previously identified as a risk factor for atherosclerosis is found in HIV-infected children. Treatment related improvements in immune function appear to be associated with these changes.
Key Words: absorptiometry, lipodystrophy, pediatrics
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