The determinants of growth failure (GF) in pediatric HIV infection are uncertain. We measured dietary intake (DI), resting energy expenditure (REE), total energy expenditure (TEE), and HIV plasma RNA (viral load: VL) in 15 prepubescent HIV+ subjects with and 21 without GF, ages 4-12 years. GF was defined as 12 month growth velocity ≤5th percentile. DI was measured by 3 day food records, REE by indirect calorimetry, TEE by the doubly-labelled water technique, VL by a PCR method (Roche), and fat free mass (FFM) by dual X-ray absorptiometry. The GF+ group was older (p=0.014), had lower CD4+ lymphocyte count, and had higher VL than the GF- group. The GF+ group had lower values for height-for-age (p<0.0001), weight-for-age (p=0.001), and age-adjusted FFM (p=0.0003) than the GF-group. DI was significantly lower in GF+ children, while REE and TEE were similar in the two groups. In conclusion, decreased DI is the most important mediator of GF in HIV+ children. The mechanism underlying decreased DI may be related to viral replication. Abnormalities in REE and TEE do not appear to be factors in HIV-associated GF. Table

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