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Stephen M. Arpadi, MD, MS; Mary N. B. Horlick, MD; Jack Wang, MS; Patricia Cuff, RD, MPH; Marukh Bamji, MD; Donald P. Kotler, MD

Arch Pediatr Adolesc Med. 1998;152:688-693.

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.

From the Department of Pediatrics (Drs Arpadi and Horlick and Ms Cuff), Division of Epidemiology (Dr Arpadi), Department of Medicine (Dr Kotler), and Body Composition Unit (Mr Wang), Columbia University, College of Physicians and Surgeons and School of Public Health, St Luke's–Roosevelt Hospital Center; and Department of Pediatrics, New York Medical College, Metropolitan Hospital Center (Dr Bamji); New York, NY.

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