OBJECTIVE:To compare growth, lipids and adipocytokines in HIV-positive children with and without lipoatrophy. PATIENTS:Eleven HIV-positive children with facial lipoatrophy, and 22 age- and sex-matched HIV-positive controls without signs of fat abnormality. METHODS:Clinical data including height, physical examination findings, medications, markers of viral control, cholesterol, and triglycerides were retrieved from the medical charts. Serum samples were analyzed for adiponectin, inflammatory markers, and high density lipoprotein cholesterol (HDL). RESULTS:Lipoatrophy was associated with higher triglycerides (330 vs 133 mg/dl, p = 0.0003), lower HDL (33 vs 48 mg/dl, p = 0.02), and a greater frequency of hypercholesterolemia (total cholesterol > 200 mg/dl; 64% vs 23%, p < 0.03). Adiponectin was 53% lower in patients with lipodystrophy (6.9 microg/ml vs 14.8 microg/ml, p = 0.005), however there was no difference in the inflammatory markers soluble TNFa receptor 2 or interleukin 6. Strikingly, despite similar BMI z-scores and virological control, lipoatrophic patients were shorter by 1 standard deviation score (p = 0.03). CONCLUSIONS:The presence of facial lipoatrophy in a child with HIV infection is a marker for significant metabolic derangements including dyslipidemia and hypoadiponectinemia, and suggests the need for careful growth evaluation.