Do children with perinatally acquired HIV infection have problems with metabolism and body shape?

Kathy Mulligan of UCSF presented data on behalf of a large Paediatric ACTG cohort (127 boys, 113 girls) with prolonged antiretroviral exposures who were compared to HIV-uninfected control children. The children receiving PI tended to have slightly more advanced HIV disease and longer durations of therapy than those on non-PI regimens.

Total fat and limb fat were lower in both PI and no-PI groups but even though BMI was less in the HIV-infected subjects in general, trunk fat was not different in the PI-treated individuals – suggesting that perhaps PIs led to greater trunk fat accumulation in these patients.

Lean body mass was similar to controls in both groups, which meant that the difference in BMI between HIV-infected children and controls was primarily due to loss of (or conversely, failure to gain) body fat. Other than triglycerides being slightly higher in the non-PI subjects, compared to controls lipid values were quite similar. But the PI-treated children had much greater elevations in triglycerides, but unlike the no-PI kids, the PI group also had significantly higher total cholesterol, LDL cholesterol, and non-HDL cholesterol levels and lower HDL cholesterol levels.

There was evidence for increased insulin resistance in both of the HIV-positive groups.

While these data are not as valuable as those from a randomised trial, they do suggest that attention needs to be paid to managing cardiovascular risk factors in children with HIV and perhaps greatest emphasis should be for those with more advanced HIV disease and those receiving PI therapy.

It is not clear however, that PI use should be avoided in these children. Kathy Mulligan emphasised these were preliminary results and they continue to review the data for subsequent reporting.

Mulligan K et al. Dyslipidemia in vertically infected children and youth on protease inhibitor (PI)-containing antiretroviral therapy (ART): preliminary results of PACTG 1045.