Lipodystrophy worsens and becomes more common the longer HIV-positive children are treated with HAART, according to Italian research published in the April 15th 2003 edition of the Journal of Acquired Immune Deficiency Syndromes.
In a prospective study, investigators in Milan compared changes in body fat composition between 37 HIV-positive children with 52 controls, who were matched according to age, sex, body mass index (BMI), and stage of disease.
To assess rates of fat loss in the face and limbs, investigators used a DXA scan. Central fat accumulation was measured using MRI scans.
At the start of the study, all the HIV-positive children were responding well to HAART, with an average CD4 cell count of 948, and all 37 had an undetectable viral load. All the children were receiving an anti-HIV regimen consisting of the NRTIs 3TC and d4T and a protease inhibitor. Follow-up was for twelve months. The majority of the children, 26, had entered puberty at the start of the study, and another five became pubescent during the twelve months of the investigation. At baseline, six children had clinically recognisable lipodystrophy.
Viral load remained undetectable in all the children during the twelve months of follow-up and CD4 cell count remained stable. However, the number of children with clinical lipodystrophy increased to eight. DXA scans showed that the total lean body mass in HIV-positive children increased significantly, particularly in the arms and legs. Although total regional fat mass remained unchanged, there was an increase in trunk fat mass, and the ratio of fat in the limbs/trunk altered, with a significant reduction in the fat levels in the arm and leg detected.
Fat changes were significantly different in the HIV-positive children to the healthy controls. The HIV-infected children were losing fat from the limbs when the HIV-negative children were gaining fat in these areas.
All the eight children with lipodystrophy had a combination of peripheral fat loss and central fat accumulation. However, in the other 29 children, the limbs appeared visibly thinner in 19, even though lipodystrophy was not diagnosed.
When the investigators looked at the risk factors for the development of lipodystrophy they found that stage of puberty and total length of exposure to HAART were the only factors predictive of the development of the syndrome. Protective factors appeared to be body mass index and sex, with girls protected by the fat pattern in their limbs.
The investigators point out that central fat accumulation has been associated with high blood pressure in obese HIV-negative children, and they also stressed the negative impact which body shape changes could have on the body shape perceptions of adolescents.
In conclusion, the investigators note, “that changes in body composition related to [lipodystrophy] syndrome occurred frequently and are a precocious and progressive phenomenon in HIV-infected children treated with PI-based HAART regimen.”
Further information on this website
Body fat changes on HAART - overview
Lipodystrophy - factsheet
Lipodystrophy - booklet in the information for HIV-positive people series
Treatments for children - overview
Differences between adults and children - overview
Vigano A et al. Increased lipodystrophy is associated with increased exposure to highly active antiretroviral therapy in HIV-infected children. JAIDS, 32: 482 – 489, 2003.