Growth velocity, fat-free mass and energy intake are inversely related to viral load in HIV-infected children

The study objectives were to assess the relationships among human immunodeficiency virus (HIV) replication, energy balance, body composition and growth in children with HIV-associated growth failure (GF). Energy intake and expenditure, body composition and level of HIV RNA were measured in 16 HIV-infected children with growth failure (HIV+/GF+), defined as a 12-mo height velocity less than or equal to 5th percentile for age, and 26 HIV-infected children with normal rates of growth (HIV+/GF-). Energy intake was measured by repeated 24-h dietary recall, resting energy expenditure (REE) by indirect calorimetry and total energy expenditure (TEE) by the doubly labeled water method. Fat-free mass (FFM) was determined by dual X-ray energy absorptiometry and plasma HIV RNA by the polymerase chain reaction method. The mean plasma HIV RNA content among the HIV+/GF+ group was nearly 1.5 log higher than that of the HIV+/GF- group (4.89 +/- 1.08 vs, 3.43 +/- 1.64 x 10(2) copies/L, P = 0.009). The mean daily energy intake, and age-adjusted REE and TEE were lower in HIV+/GF+ children (P = 0.003, 0.06 and 0.16, respectively). HIV+/GF+ children had a mean daily energy deficit of 674 +/- 732 kJ/d compared with HIV+/GF- children who had a mean energy surplus of 1448 +/- 515 kJ/d (P = 0.030). There were no differences in REE after adjustment for differences in FFM and age using multiple regression analysis (P = 0.88). There was a significant inverse relationship between FFM and plasma HIV RNA [R-2 = 0.64, standard error of the estimate (SEE) = 3.23] and between viral load and 12-mo growth velocity (R-2 = 0.61, SE = 1.51). Viral load and energy intake were also inversely related (R2 = 0.17, SEE = 573.2, P = 0.0125). In HIV-infected children, rate of growth, quantity of FFM and energy intake are closely related to the level of HIV replication. The energy intake of children with HIV-associated GF may not be adequate for supporting normal development of FFM and growth, despite possible decreases in total energy expenditure.