Children with HIV (CHIV) are exposed to antiretrovirals (ART) for the rest of their lives; thus, tailoring their regimens to have the least influence on fat redistribution is a top goal. This is a cross-sectional research in Johannesburg, South Africa, involving 219 perinatally infected CHIV and 219 HIV-uninfected controls from similar socioeconomic backgrounds. Researchers examined total body and regional fat distribution in CHIV on suppressive ART regimens to controls, as well as between CHIV on ritonavir-boosted lopinavir (LPV/r) and efavirenz (EFV)-based regimens. The 219 uninfected children and 219 CHIV children had a mean age of 7.0 and 6.4 years, respectively. CHIV children exhibited lower adjusted total body fat and lower percentage fat in the trunk, arms, and legs compared to uninfected children. Except for arm fat accumulation, CHIV on LPV/r exhibited identical body composition to those on EFV. Girls with HIV on LPV/r exhibited lower adjusted total, trunk, arms, and legs fat mass; lower trunk-to-total body fat ratio; and greater legs-to-total body fat ratio than those on EFV.

South African CHIV taking ART had lower total and partial fat mass, as well as a lower percentage of fat, than healthy controls. Switching from LPV/r to EFV in females with HIV with persistent virologic suppression on ART might reduce fat mass loss, indicating that an EFV-based regimen may be a preferable alternative in this group of individuals.