Background: We conducted a prospective observational study to describe changes in body composition in HIV-infected children for 48 weeks (wks) after starting on or switching to combination antiretroviral chemotherapy including at least 2 new drugs, and to correlate such changes with changes in levels of plasma HIV-1 RNA and CD4⁺ T-lymphocytes.

Methods: Anthropometric, bioimpedance, and laboratory measures were evaluated every 12 wks in 63 Tanner stage 1 HIV-infected children aged 1 month to < 13 years enrolled in PACTG 1010. Data were analyzed by linear growth mixed effects modeling and by regression analysis.

Results: Log₁₀ relative changes from baseline are shown (absolute change for z-scores). The proportion of subjects with HIV RNA < 400/mL increased from 2% at entry to 51% at 12 wk and was 40% at 48 wk. Median absolute CD4⁺ count change was +104/μL at 12 wk and +139/μL at 48 wk.

Significant negative correlations between change in RNA and changes in height, weight, fat free mass, mid arm muscle circumference, and resistance index were noted at 24 and/or 36 wks. Significant positive correlations between CD4⁺ change and changes in height and total body water were noted at 24 and/or 36 wks, and negative correlations with changes in resistance and impedance at 48 wks.

Conclusions: Increased growth z-scores, favorable changes in body composition, and unfavorable changes in glucose and lipid metabolism are apparent over the near term in children starting or switching combination antiretroviral chemotherapy. Changes in growth and body composition appear to be associated with virologic suppression and with immunologic reconstitution.

 

Mean Δ in Body Composition Measures at 48 Weeks (p)					Mean Δ in Biochemical Measures at 36 Weeks (p)
Height for age z-score, SD	+0.12	(0.037)		Total cholesterol		+7%	(< 0.001)
Weight for age z-score, SD	+0.27	(< 0.001)		Triglycerides		+12%	(0.18)
Body mass index z-score, SD	+0.16	(0.039)		Apolipoprotein A1		+5%	(0.014)
Impedance (Z)	-5%	(< 0.001)		Apolipoprotein B		+7%	(0.009)
Resistance (R)	-5%	(< 0.001)		Insulin		+66%	(< 0.001)
Reactance (Xc)	+5%	(0.046)		Glucose		+20%	(0.077)
Phase angle (P)	+7%	(0.004)		C-peptide		+35%	(< 0.001)
Total body water	+15%	(< 0.001)		Insulin-like growth factor 1		+41%	(< 0.001)
Fat free mass	+17%	(< 0.001)		IGF binding protein 1		-31%	(0.009)
Resistance index	+17%	(< 0.001)		IGF binding protein 3		-2%	(0.23)