Background:  Lipodystrophy is reported in pediatric HIV infection. However, few studies use objective measures or include healthy subjects for comparison. The study aim was to longitudinally compare regional fat distribution in perinatally HIV⁺ youth receiving ART to healthy controls (HIV^–).

Methods:  Baseline and 2 annual follow-up dual energy x-ray absorptiometry (DEXA) scans were performed in HIV⁺ and HIV^– subjects. Total, leg, arm, and trunk fat masses and fat distribution as the percentage of total body fat in each region were compared. Anthropometrics and pubertal stage were also obtained.   

Results:  We enrolled 64 HIV⁺ and 147 HIV^– subjects ages 6 to 16 years. HIV⁺ and HIV^– subjects were similar at baseline with respect to pubertal stage, sex, height-for-age, and weight-for-age. However, the HIV⁺ group was younger, 10.3 (3.7) vs 11.6 (2.8) years (mean [SD]; p = 0.002), and had a greater proportion of African Americans, 69 vs 48%, (p = 0.006). All HIV⁺ subjects were infected perinatally and receiving ≥3-drug ART. HIV⁺ and HIV^– did not differ in total fat mass or trunk fat as percentage of total, but the HIV⁺ group had significantly lower leg and greater arm fat as percentage of total at baseline, and 1 and 2 years compared to the HIV^– group. Annual gain in total, leg, and trunk fat mass did not differ between groups, but HIV⁺ gained more arm fat. Differences in arm and leg fat as percentage of total remained significant and greater trunk fat as percentage of total in HIV⁺ was revealed when age, sex, race, height, and pubertal stage were accounted for by mixed effect modeling. Differences in arm fat as percentage of total fat increased with age (see the figure). Among HIV⁺ subjects, no differences in fat distribution were observed by treatment category (zidovudine [AZT] or stavudine [d4T] vs no AZT or d4T, protease inhibitor [PI] vs no PI, NNRTI vs no NNRTI). 

Conclusions:  Serial objective measurements performed over 2 years confirm that despite having similar body fat content, perinatally HIV-infected youth have differences in the pattern of regional fat distribution than healthy subjects. This includes increased trunk and decrease leg fat, as previously reported. However, in contrast to prior reports, arm fat is significantly increased. This pattern appears to persist through sexual maturation. The metabolic implications of these findings remain to be explored.