ABSTRACT
Alterations in regional fat, often associated with abnormalities in lipid and insulin metabolism, have been reported in HIV-infected adults. To determine whether similar abnormalities occur in children with HIV, patterns of change in regional body fat distribution were determined by dual energy x-ray absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) children experienced lipodystrophy (LD), defined as extremity lipoatrophy together with trunk fat accumulation. Despite a mean body weight increase of 2.9 +/- 2.4 kg, children with LD experienced a mean loss of total fat in contrast to children without LD who increased total fat (-0.151 +/- 0.324 versus 0.981 +/- 1.041 kg; p <.01). Children with LD had significantly higher levels of HIV RNA and lower CD4 count and percentage at baseline. LD was associated with use of protease inhibitors or stavudine, (odds ratio [OR], 7.0, 95% confidence interval [CI], 1.1-45.2, p =.04; OR, 9.0, 95% CI, 1.4-59.8, p =.03, respectively). This observational study suggests that during a time in childhood when accumulation of extremity and trunk fat is expected, some HIV-infected children experience changes in fat distribution that are similar to HIV-associated LD reported in adults. Studies to determine whether HIV-infected children with changes in regional fat also experience increases in "atherogenic" lipids and insulin resistance as described in adults with HIV-associated LD are warranted.
Subject(s)
Anti-HIV Agents/adverse effects , Body Composition , HIV Infections/complications , HIV-1/physiology , Lipodystrophy/etiology , Absorptiometry, Photon/methods , Anti-HIV Agents/therapeutic use , CD4 Lymphocyte Count , Child , Drug Therapy, Combination , Female , HIV Infections/drug therapy , HIV Infections/immunology , HIV Infections/virology , HIV Protease Inhibitors/adverse effects , HIV Protease Inhibitors/therapeutic use , Humans , Lipodystrophy/immunology , Lipodystrophy/virology , Male , Reverse Transcriptase Inhibitors/adverse effects , Reverse Transcriptase Inhibitors/therapeutic use , Risk Factors , Stavudine/adverse effects , Stavudine/therapeutic use , Viral LoadABSTRACT
The study objectives were to assess the relationships among human immunodeficiency virus (HIV) replication, energy balance, body composition and growth in children with HIV-associated growth failure (GF). Energy intake and expenditure, body composition and level of HIV RNA were measured in 16 HIV-infected children with growth failure (HIV+/GF+), defined as a 12-mo height velocity = 5th percentile for age, and 26 HIV-infected children with normal rates of growth (HIV+/GF-). Energy intake was measured by repeated 24-h dietary recall, resting energy expenditure (REE) by indirect calorimetry and total energy expenditure (TEE) by the doubly labeled water method. Fat-free mass (FFM) was determined by dual X-ray energy absorptiometry and plasma HIV RNA by the polymerase chain reaction method. The mean plasma HIV RNA content among the HIV+/GF+ group was nearly 1.5 log higher than that of the HIV+/GF- group (4. 89 +/- 1.08 vs. 3.43 +/- 1.64 x10(2) copies/L, P: = 0.009). The mean daily energy intake, and age-adjusted REE and TEE were lower in HIV+/GF+ children (P: = 0.003, 0.06 and 0.16, respectively). HIV+/GF+ children had a mean daily energy deficit of 674 +/- 732 kJ/d compared with HIV+/GF- children who had a mean energy surplus of 1448 +/- 515 kJ/d (P: = 0.030). There were no differences in REE after adjustment for differences in FFM and age using multiple regression analysis (P: = 0.88). There was a significant inverse relationship between FFM and plasma HIV RNA [R:(2) = 0.64, standard error of the estimate (SEE) = 3.23] and between viral load and 12-mo growth velocity (R:(2) = 0.61, SE = 1.51). Viral load and energy intake were also inversely related (R(2) = 0.17, SEE = 573.2, P: = 0. 0125). In HIV-infected children, rate of growth, quantity of FFM and energy intake are closely related to the level of HIV replication. The energy intake of children with HIV-associated GF may not be adequate for supporting normal development of FFM and growth, despite possible decreases in total energy expenditure.
Subject(s)
Body Composition , Energy Intake , Growth , HIV Infections/physiopathology , HIV Infections/virology , Viral Load , Body Height , Body Weight , CD4 Lymphocyte Count , Child , Energy Metabolism , Female , HIV/genetics , HIV/physiology , Humans , Male , RNA, Viral/analysis , Regression AnalysisSubject(s)
Adrenocortical Hyperfunction/chemically induced , Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Hypertriglyceridemia/chemically induced , Obesity/chemically induced , Abdomen/pathology , Anti-HIV Agents/administration & dosage , Child , Drug Therapy, Combination , Humans , Infectious Disease Transmission, Vertical , Magnetic Resonance Imaging , MaleABSTRACT
OBJECTIVE: To characterize the body composition of human immunodeficiency virus (HIV)-infected children, especially those with growth failure (GF), using laboratory-based methods. DESIGN: A cross-sectional study of body composition measurements. SETTING: Urban, hospital-based body composition laboratory. PARTICIPANTS: Thirty-four prepubertal children with HIV infection, aged 4 to 11 years, recruited from a pediatric HIV clinic. Eighteen HIV-infected children with GF, 16 HIV-infected children with normal rates of growth, and 52 healthy children were studied. MAIN OUTCOME MEASUREMENTS: Anthropometrics, body cell mass (BCM) by total body potassium counting, body fat percent, fat mass, and fat-free mass (FFM) by dual-energy x-ray absorptiometry were determined. RESULTS: Both groups of boys with HIV infection had significantly lower FFM/height ratios compared with healthy boys. The mean BCM/height ratio was also lower in HIV-infected boys with GF compared with healthy boys. Measures of fat of the HIV-infected boys with GF did not differ from healthy controls, but a statistical trend suggesting decreased body fat percent and fat mass/height ratio was observed in HIV-infected boys without GF (P=.06 and .07, respectively). Mean height-for-age, weight-for-age, and weight-for-height percentiles were significantly decreased in HIV-infected boys regardless of growth status as compared with healthy boys. The mean FFM/ height and BCM/height ratios were decreased in HIV-infected girls with GF compared with healthy girls. Body fat percentage and fat mass/height ratio did not differ among the 3 groups of girls. The mean weight-for-height percentiles were not different among the 3 groups of girls. The HIV-infected girls with GF had significantly lower mean height-for-age and weight-for-age percentiles than HIV-infected girls without GF and healthy girls. The mean height-for-age percentiles of the HIV-infected girls with GF did not differ from the healthy girls. CONCLUSIONS: Boys and girls with HIV-associated GF had diminished FFM and BCM. The decrease in FFM and BCM was in striking contrast to the fat compartment, which was normal. Decreased FFM was also detected in boys with HIV infection and normal growth but not in girls with HIV infection and normal growth, suggesting that HIV infection may affect boys differently than girls. The preferential decrease in FFM and BCM over fat observed in these children is similar to findings reported in adults with acquired immunodeficiency syndrome wasting.
Subject(s)
Body Composition , HIV Infections/physiopathology , Anthropometry , Body Constitution , Child , Child, Preschool , Cross-Sectional Studies , Female , Growth Disorders/etiology , Growth Disorders/physiopathology , HIV Infections/complications , Humans , MaleABSTRACT
The purpose of this study was to evaluate the performance of bioimpedance analysis (BIA) in the prediction of total body water and fat free mass with the use of standard equations in assessing 20 prepubertal children infected with human immunodeficiency virus (HIV). Total body water was measured by means of deuterium oxide dilution, fat free mass by means of total body dual X-ray absorptiometry, and BIA with a bioelectrical impedance analyzer. The use of standard prediction equations resulted in substantial error. Regression equations using height and BIA resistance for estimating total body water and fat free mass were developed and appear to improve accuracy for prediction. This study suggests that total body water and fat free mass can be estimated in children with HIV by means of BIA equations specifically developed for use with this group of children.
Subject(s)
Body Composition , Electric Impedance , HIV Infections/physiopathology , Adipose Tissue , Body Water , Child , Child, Preschool , Female , Humans , Male , Predictive Value of Tests , Puberty , Regression AnalysisABSTRACT
The aim of this study was to determine the feasibility, tolerance, and efficacy of enteral feeding in malnourished AIDS patients. This was a prospective study of eight AIDS patients with severe eating disorders associated with systemic diseases. A defined diet was administered through an endoscopically placed gastrostomy tube. Body composition studies and selected serum and immunologic studies were done at baseline and monthly for 2 mo. Enteral feeding was associated with an increase of approximately 14% in total body potassium, an index of body cell mass (P less than 0.02), and an increase in body fat content (P less than 0.002). Serum albumin concentration (P less than 0.005) and iron-binding capacity also rose. Serum immunoglobulins did not change. The numbers of total lymphocytes (P less than 0.005) and CD8+ cells rose but CD4+ cells did not change. The tube and enteral feedings were well tolerated. These results demonstrate that enteral feeding may result in body-cell-mass repletion in malnourished AIDS patients.