650   Metabolic and Body Composition Changes in HIV- Infected Children on Antiretroviral Therapy.

G. Meneilly*, J. Forbes, D. Peabody, V. Remple, and D. Burdge.
Children's and Women's Health Ctr. of BC, Univ. of British Columbia, Vancouver, Canada.

Background:Metabolic and body composition changes associated with antiretroviral therapy (ART) have been well documented in HIV-infected adults, but there have been few reports in children. This observational study determined the frequency of metabolic and body composition changes in 29 HIV-infected children on ART and the relationship between these abnormalities and use and duration of PI, NNRTI, and D4T therapy.

Methods:Fasting plasma glucose, triglycerides (TG), total cholesterol (chol), HDL and LDL were measured. Fat accumulation and depletion were determined by anthropometrics and clinical examination. Body mass index (BMI) for age percentile was determined using standard graphs. Duration of ART was defined as time to first documented abnormality or as of 09/00 for children with no abnormalities. Statistical testing was performed using Fisher's exact test and Kruskal-Wallis analysis of variance.

Results:Twenty-nine children (17 male) received ART for a median duration of 44 mos. (12—124). Median age was 6.88 yrs. (2—12.9). Eighteen children (62%) had metabolic or body composition changes. Eight (28%) had changes in fat distribution: 4 (14%) had fat accumulation (abdomen, back and neck), 6 (21%) had fat depletion (face, arms and legs), and 2 (7%) had both. Seventeen (59%) had metabolic changes: 12 (41%) had increased TG (>95th percentile: median 1.85mmol/L; 1.51—2.85), 12 (41%) had increased chol (>5mmol/L: median 5.5; range 5—5.98) and 7 (24%) had both. None had abnormal fasting glucose. There were no differences in BMI percentiles for children receiving a PI, NNRTI or D4T (p = 0.726). There was no significant difference in duration of PI, NNRTI, or D4T therapy between children who had body composition or metabolic abnormalities and those who did not. More children with body composition changes had ever received D4T (P = 0.033).

Conclusion:A significant number (62%) of children on ART develop changes in metabolic parameters or body composition, although the relationship to use and duration of ART is unclear. The long-term clinical implications of these changes have yet to be determined.