681-T.
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HAART-Associated Changes in Body Fat Distribution Are Detectable in HIV-Infected Children Even in the Absence of Clinical Evidence of Lipodystrophy
A. Vigaṇ*1, D. Bricalli1, N. Sala1, F. Renzetti2, P. Manzoni2, A. Vanzulli3, and P. Brambilla2
1L. Sacco Hosp., Milan; 2HSR, Milan; and 3Ca' Granda Hosp., Milan, Italy
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Background: Dual-energy X-ray Absorptiometry (DXA) quantifies precisely lean and fat compartments and it is considered at the moment the gold standard for in vivo body composition studies in children; moreover it allows a regional analysis for fat distribution between limbs and trunk. Magnetic resonance imaging (MRI) in adult and in children studies showed greater accuracy in quantifying intraabdominal adipose tissue (IAT) in patients affected by body composition abnormalities. Combined use of DXA and MRI allow a precise estimate of regional body composition and IAT. Data on body composition in vertically HIV-infected children (HIV+) on HAART with (LD+) and without (LD-) lipodystrophy are lacking.
Methods: DXA scans were performed in 34 HIV+: 6 HAART-treated children with lipodystrophy (LD+) and 28 HAART-treated children without lipodystrophy (LD-) and in the same number of matched healthy controls (defined as HC+ and HC- respectively). MRI scans were performed in 16 HIV+: 6 LD+ , 10 LD-, and 16 pair-matched (age and sex) HC.
Results: LD+ and LD- were similar for: months of previous exposure to NRTIs (45.5 vs 39.5) and months on HAART (39.3 vs 39.1), CD4+/muL (1227 vs 936), percentage of patients with HIV-RNA < 50 copies/mL (100 vs 96.4). Lean mass in LD+ and in LD- children was similar to that observed in their controls. Fat mass was lower in LD- children as compared to their HC- (p=0.03); fat mass was lower, but not significantly, also in LD+ children as compared to their pair matched HC+. The percentage ratio between fat and lean mass was lower both in LD+ and LD- children than in their controls (p=0.005). Fat limbs/Fat trunk ratio is reduced: 0.69 LD+ vs 1.51 HC+ (p=0.001) and 1.01 LD- vs 1.66 HC- (p<0.001); Fat trunk/Fat total ratio is increased: 0.54 LD+ vs 0.38 HC+ (p=0.001) and 0.47 LD- vs 0.35 HC- (p<0.0001); Fat limbs/Fat total ratio is reduced: 0.37 LD+ vs 0.55 HC+ (p<0.0001) and 0.44 LD- vs 0.56 HC- (p=0.009). LD+ showed higher Fat trunk/Fat total (p=0.04) and lower Fat limbs/Fat total ratios (p=0.009) than LD-.
Conclusions: Increased central fat and peripheral lipoatrophy are distinctive features of all HAART-treated children. Changes in fat distribution are detectable by DXA even in the absence of clinical evidence of lipodystrophy. Increased truncal adiposity could involve intraabdominal fat depots, with well-known metabolic consequences.
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