Viganò Alessandra, Mora Stefano, Testolin Corrado, Beccio Sabrina, Schneider Laura, Bricalli Dorella, Vanzulli Angelo, Manzoni Paola, Brambilla Paolo
Department of Pediatrics, L. Sacco Hospital, via GB Grassi 74, 20157 Milan, Italy.
J Acquir Immune Defic Syndr. 2003 Apr 15;32(5):482-9. doi: 10.1097/00126334-200304150-00003.
To assess body composition changes in HIV-infected children receiving highly active antiretroviral therapy (HAART).
Thirty-seven HIV-positive children were enrolled. Dual-energy X-ray absorptiometry (DXA) scans were performed in all HIV-infected children at baseline and after an additional 12 months of HAART and in 54 matched (for sex, age, body mass index [BMI], and pubertal stage) healthy controls. Abdominal MRI was performed in 14 of 37 HIV-positive children at baseline and in 28 of 37 HIV-positive children after additional 12 months of HAART.
During the study period, mean HAART exposure increased from 39.3 to 50.9 months and the number of HIV-infected children with clinical lipodystrophy (LD) increased from 6 to 8, whereas mean BMI, CD4 percentage, and percentage of HIV-infected children with HIV RNA <50 copies/mL did not change. DXA scans showed an increase in lean mass, peripheral fat loss, and central fat accumulation in all HIV-infected children. As compared with controls, 70% and 84% of HIV-infected children showed DXA-detectable LD at baseline and at 12 months of follow-up, respectively. Mixed LD and central fat accumulation were the most common LD phenotype. At baseline and at 12 months of follow-up, intra-abdominal adipose tissue (IAT) was greater than in controls in 33% and 35% of HIV-infected children, and it was greater in those with LD than in those without. Peripheral fat loss and IAT content were associated with duration of HAART and were independent of immunologic stage of disease and immunologic response.
Changes in body composition related to LD in HAART-treated children are frequent, precocious, and progressive. Duration of HAART negatively influences visceral adiposity and peripheral fat loss.
评估接受高效抗逆转录病毒治疗（HAART）的HIV感染儿童的身体成分变化。
纳入37名HIV阳性儿童。对所有HIV感染儿童在基线时以及接受额外12个月HAART治疗后进行双能X线吸收测定（DXA）扫描，并对54名匹配（性别、年龄、体重指数[BMI]和青春期阶段）的健康对照者进行扫描。对37名HIV阳性儿童中的14名在基线时进行腹部MRI检查，对37名HIV阳性儿童中的28名在接受额外12个月HAART治疗后进行腹部MRI检查。
在研究期间，HAART的平均暴露时间从39.3个月增加到50.9个月，临床脂肪营养不良（LD）的HIV感染儿童数量从6名增加到8名，而平均BMI、CD4百分比以及HIV RNA<50拷贝/mL的HIV感染儿童百分比没有变化。DXA扫描显示所有HIV感染儿童的瘦体重增加、外周脂肪减少和中心脂肪堆积。与对照组相比，分别有70%和84%的HIV感染儿童在基线和随访12个月时显示出DXA可检测到的LD。混合型LD和中心脂肪堆积是最常见的LD表型。在基线和随访12个月时，分别有33%和35%的HIV感染儿童的腹内脂肪组织（IAT）大于对照组，且有LD的儿童的IAT大于无LD的儿童。外周脂肪减少和IAT含量与HAART治疗时间相关，且独立于疾病的免疫阶段和免疫反应。
接受HAART治疗的儿童中与LD相关的身体成分变化常见、早熟且呈进行性。HAART治疗时间对内脏脂肪增多和外周脂肪减少有负面影响。
