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To estimate prevalence of body fat redistribution and dyslipidaemia in HIV-infected children and to assess associated risk factors, ultimately to inform the definition of lipodystrophy in children.Cross-sectional observational study.During a 2–3 month period, 477 HIV-infected children aged ≥ 3 years (median 9.78; range, 3–18) in 30 paediatric HIV clinics were assessed at their first visit. Sociodemographic, clinical and immunological data were recorded and the presence or absence of clinical signs of fat redistribution (peripheral lipoatrophy and central lipohypertrophy) determined according to an agreed protocol. Laboratory indicators of lipid/glucose metabolism were recorded for all children in 18 centres.Prevalence was 26.0% [95% confidence interval (CI), 22.1–30.2] for any fat redistribution, 8.81% (95% CI, 6.42–11.7) for central lipohypertrophy, 7.55% (95% CI, 5.34–10.3) for peripheral lipoatrophy and 9.64% (95% CI, 7.15–12.7) for the combined subtype (more than one sign of each). Independent predictors of fat redistribution included Centers for Disease Control and Prevention class C disease, female gender, ever used versus never use of protease inhibitors and of stavudine. Increasing time since initiation of antiretroviral therapy was associated with increased severity of fat redistribution. In the metabolic assessment subgroup, 27% (95% CI, 21.6–32.7) of children had hypercholesterolaemia and 21% (95% CI, 16.4–26.6) hypertriglyceridaemia; however, significantly more children had fat redistribution in this subgroup than overall (31%).Approximately a quarter of children and adolescents could be taken to have signs of lipodystrophy, with clinical presentation and risk factors similar to those described in adults.