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Switch to Efavirenz Attenuates Lipoatrophy in Girls With Perinatal HIV

Junwei Su1, Stephanie Shiau2, Stephen M Arpadi3,4,5

  • 1The Department of Infectious Diseases, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Journal of Pediatric Gastroenterology and Nutrition
|August 18, 2020
PubMed

Insights

Children with HIV on antiretroviral therapy (ART) showed reduced body fat compared to controls. For girls with HIV, efavirenz-based ART may be preferable to lopinavir/ritonavir for preserving fat mass.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Metabolic Health

Background:

  • Children with HIV (CHIV) experience lifelong antiretroviral therapy (ART).
  • Optimizing ART regimens to minimize impact on fat redistribution is crucial for CHIV's long-term health.
  • Understanding body composition changes in CHIV is essential for managing potential metabolic complications.

Purpose of the Study:

  • To compare total body and regional fat distribution in CHIV on suppressive ART with HIV-uninfected controls.
  • To investigate differences in body composition between ritonavir-boosted lopinavir (LPV/r)-based and efavirenz (EFV)-based ART regimens in CHIV.

Main Methods:

  • Cross-sectional study in Johannesburg, South Africa, involving 219 perinatally infected CHIV and 219 HIV-uninfected controls.
  • Comparison of total body and regional fat distribution between CHIV and controls.
  • Analysis of body composition differences between LPV/r-based and EFV-based ART regimens within the CHIV group, stratified by sex.

Main Results:

  • CHIV exhibited significantly lower adjusted total body fat and fat percentage in the trunk, arms, and legs compared to uninfected children.
  • Overall, CHIV on LPV/r and EFV regimens showed similar body composition, with a notable exception in arm fat mass.
  • In girls with HIV, LPV/r was associated with lower total, trunk, arm, and leg fat mass, and altered trunk-to-total and legs-to-total body fat ratios compared to EFV.

Conclusions:

  • CHIV receiving ART in South Africa demonstrated reduced global and partial fat mass and percentage fat compared to healthy controls.
  • For girls with HIV on ART with sustained virologic suppression, switching from LPV/r to EFV may help preserve fat mass.
  • EFV-based regimens may represent a more favorable option for managing body composition in this specific group of CHIV.
Abstract

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