|Jacobson, Denise L.|
|Siberry, George K.|
|Van Dyke, Russell B.|
|Dimeglio, Linda A.|
|Geffner, Mitchell E.|
|Chen, Janet S.|
|Mcfarland, Elizabeth J.|
|Fielding, Roger A.|
|Miller, Tracie L.|
Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/13/2011
Publication Date: 12/1/2011
Citation: Jacobson, D., Patel, K., Siberry, G., Van Dyke, R., Dimeglio, L., Geffner, M., Chen, J., Mcfarland, E., Borkowsky, W., Silio, M., Fielding, R., Siminski, S., Miller, T. 2011. Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study. American Journal of Clinical Nutrition. 92(6):1485-1495. Interpretive Summary: Abnormal body fat distribution is a consequence of childhood HIV infection. It is unclear if this abnormal distribution is a consequence of the actual HIV infection or a product of the potent drug regimens used to keep the virus in check (anti-retroviral therapy). Children aged 7-16 years in the Pediatric HIV/AIDS Cohort (PHACS) Study were evaluated for their body fat distribution and quantity. We compared HIV-infected (HIV) and HIV-exposed, uninfected (HEU) children. HIV had 5% lower percent body fat, 2.6% lower percent extremity fat (EF), 1.4% higher percent trunk fat (TF), and 10% higher trunk-to-extremity fat ratio (TEFR) than HEU. Although HIV-infected children had a significantly lower BMI and total body fat than HEU, their body fat distribution followed a pattern associated with increased cardiovascular risk.
Technical Abstract: Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Our objective was to compare total body fat and its distribution in perinatally HIV-infected and HIV-exposed but uninfected (HEU) children and to evaluate associations with clinical variables. In a cross-sectional analysis, children aged 7–16 y in the Pediatric HIV/AIDS Cohort Study underwent regionalized measurements of body fat via anthropometric methods and dual-energy X-ray absorptiometry. Multiple linear regression was used to evaluate body fat by HIV, with adjustment for age, Tanner stage, race, sex, and correlates of body fat in HIV-infected children. Percentage total body fat was compared with NHANES data. Males accounted for 47% of the 369 HIV-infected and 51% of the 176 HEU children. Compared with HEU children, HIV-infected children were older, were more frequently non-Hispanic black, more frequently had Tanner stage 3, and had lower mean height (20.32 compared with 0.29), weight (0.13 compared with 0.70), and BMI (0.33 compared with 0.63) z scores. On average, HIV-infected children had a 5% lower percentage total body fat (TotF), a 2.8% lower percentage extremity fat (EF), a 1.4% higher percentage trunk fat (TF), and a 10% higher trunk to-extremity fat ratio (TEFR) than did the HEU children and a lower TotF compared with NHANES data. Stavudine use was associated with lower EF and higher TF and TEFR. Non-nucleotide reverse transcriptase inhibitor use was associated with higher TotF and EF and lower TEFR. Although BMI and total body fat were significantly lower in the HIV-infected children than in the HEU children, body fat distribution in the HIV-infected children followed a pattern associated with cardiovascular disease risk and possibly related to specific antiretroviral drugs.