Paper # 868 
Differences in Body Fat Distribution in HIV-infected vs HIV-uninfected Children
Denise Jacobson*1, K Patel1, R Van Dyke2, R Hazra3, M Geffner4, L DiMeglio5, S Siminski6, M Silio2, E McFarland7, T Miller8, and Pediatric HIV/AIDS Cohort Study
1Harvard Sch of Publ Hlth, Boston, MA, US; 2Tulane Univ Hlth Sci Ctr, New Orleans, LA, US; 3Natl Inst of Child Hlth and Human Devt, NIH, Bethesda, MD, US; 4Children’s Hosp Los Angeles, Univ of Southern California, Keck Sch of Med, US; 5Indiana Univ Sch of Med, Indianapolis, US; 6Frontier Sci and Tech Res Fndn, Buffalo, NY, US; 7Univ of Colorado Hlth Sci Ctr, Denver, US; and 8Univ of Miami Miller Sch of Med, FL, US
Background: Adverse changes in body composition are
frequent in HIV disease. We compared body fat distribution in perinatally
HIV-infected (HIV+) to HIV-exposed, uninfected (HIV‑)
children aged 7 to 16 years enrolled in the Adolescent Master Protocol (AMP) of
the Pediatric AIDS/HIV Cohort Study (PHACS). We also evaluated clinical risk
factors for fat redistribution among HIV-pos children.
Methods: Dual energy x-ray absorptiometry (DXA)
assessed total body mass (TBM), total body fat (TBF), extremity fat (EXF) and
trunk fat (TRF). Fat outcomes were defined as % total fat [(TBF/TBM) *100], %
extremity fat [(EXF/TBF)*100], % trunk fat [(TRF/TBF)*100] and
trunk-to-extremity fat ratio (TRF:EXF). We fit multiple linear regression
models to evaluate differences in fat by HIV status, adjusted for age, Tanner
stage, race and sex, and to identify clinical correlates of fat outcomes in HIV+
children.
Results: DXA were obtained on 303 HIV+
and 115 HIV‑ children. The HIV+ were older (12.5 vs
10.7 years), more frequently African American (74% vs 57%) and Tanner >3
(54% vs 34%). A similar proportion were male (46% vs 52%). HIV+ had
a lower BMI-z (median 0.27 vs 0.95) than HIV‑ children. HIV+
had median CD4 of 699 cells/mm3 and 44% had viral load <400
copies/mL. Use of highly active antiretroviral therapy (HAART) was high (87%)
(HAART-protease inhibitor (PI) 73%; HAART without PI 14%; non-HAART ARV 6%; No
ARV 7%). HIV+ children had lower % total body fat, lower % extremity
fat and a borderline higher % trunk fat than HIV‑ (Table).
Trunk-to-extremity fat ratio was 1.09 times higher in HIV+ than HIV‑.
Among HIV+, children who had a lifetime use of PI for >2
years had higher % trunk fat than those who used PI for <2 years or not at
all (P =0.025). CD4 count and detectable viral load were not
associated with fat distribution.
Conclusions: Loss of extremity fat and a trend
toward higher truncal adiposity were observed in HIV-infected children compared
to HIV‑ and may be related to longer-term use of protease
inhibitors. These alterations in body fat may increase the risk of
cardiovascular disease outcomes.
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