Background:HIV-infected adults with lipodystrophy, characterized by excess accumulation of intra-abdominal adipose tissue (IAT), showed impaired growth hormone (GH) secretion. Data are lacking in paediatric lipodystrophy with the same features.Methods:Twenty-five pubertal HIV-infected children were assessed for GH response (GH-AUC0–120min) to arginine + GHRH testing, insulin-like growth factor-1 (IGF-1), IGF binding protein 3 (IGFBP-3), insulin, glucose, cholesterol, triglycerides, free fatty acids and nitric oxide levels. Body composition and IAT content were evaluated by dual-energy x-ray-absorptiometry and magnetic resonance imaging. An excess accumulation of IAT was defined as a value > 41 cm2. Differences between children with (V+) and without (V–) excess IAT were assessed by non-parametric tests and multivariate analysis.Results:Ten V+ (mean IAT, 82.5 cm2) and 15 V– (mean IAT, 26.8 cm2) were identified; they were similar for age (13.8 versus 14.8 years), body mass index (20.2 versus 19.5 kg/m2), male : female ratio (3/7 versus 8/7), months on highly active antiretroviral therapy (54.5 versus 55 months). V+ showed lower GH-AUC0–120min(16.4 versus 31.6 μg⋅h/l;P= 0.002), lower IGF-1 concentrations (384 versus 515 ng/ml;P= 0.03) and higher insulin levels (17.8 versus 10.5 μIU/ml;P= 0.01) than V–. V+, as compared to V–, showed lower lean mass (total,P= 0.025; arms,P= 0.024; legs,P= 0.008) and higher fat mass (total,P= 0.0038; arms,P= 0.028; trunk,P <0.0001). Lipid profile and glucose, IGFBP-3, nitric oxide and free fatty acids levels were similar in the two groups. GH-AUC0–120mincorrelated negatively with IAT content and insulin levels.Conclusion:Impaired GH secretion is detectable in pubertal children with increased visceral adiposity and hyperinsulinemia. GH therapy should be considered in lipodystrophic HIV-infected children with excess IAT.