Abstract
BackgroundFat abnormalities are common among HIV-infected persons, but few studies have compared regional body fat distribution, including visceral fat, in HIV-infected and HIV-uninfected persons and their subsequent trajectories in body composition over time.MethodsBetween 1999 and 2002, 33 men with clinical evidence of lipodystrophy (LIPO+), 23 HIV-infected men without clinical evidence of lipodytrophy (LIPO-), and 33 HIV-uninfected men were recruited from the four sites of the Multicenter AIDS Cohort Study (MACS). Participants underwent dual-energy x-ray absorptiometry, quantitative computerized tomography of the abdomen and thigh, and circumference measurements of the waist, hip and thigh. Circumference measurements at each semi-annual MACS visit between recruitment and 2008 were used to compare average annual anthropometric changes in the 3 groups.ResultsBody mass index (BMI) was lower in LIPO+ men than in the LIPO- men and the HIV- uninfected controls (BMI: 23.6 ± 0.4 vs 26.8 ± 1.5 vs 28.7 ± 0.9 kg/m2, respectively, p < 0.001). The average amount of visceral adipose tissue (VAT) was similar in all three groups (p = 0.26), but after adjustment for BMI, VAT was higher in the LIPO+ group (169 ± 10 cm2) compared to the LIPO- men (129 ± 12 cm2, p = 0.03) and the HIV-uninfected group (133 ± 11 cm2, p = 0.07). Subcutaneous adipose tissue (thigh, abdomen) and total extremity fat were less in the HIV-infected men (LIPO+ and LIPO-) than in the HIV-uninfected men. Over an average of 6 years of follow-up, waist circumference increased at a faster rate in LIPO+ group, compared to the LIPO- men (0.51 cm/year vs 0.08 cm/year, p = 0.02) and HIV-uninfected control men (0.21 cm/year, p = 0.06). The annual changes in hip and thigh circumferences were similar in all three groupsConclusionSubcutaneous lipoatrophy was observed in HIV-infected patients, even those without clinical evidence of lipodystrophy, compared to age-matched HIV-uninfected men. Despite markedly lower BMI, HIV-infected men with lipodystrophy had a similar amount of VAT as HIV-uninfected men and tended to have more rapid increases in waist circumference over 6 years of follow-up. These longitudinal increases in waist circumference may contribute to the development of cardiovascular risk in HIV-infected patients with lipodystrophy.
Highlights
In the era of highly active antiretroviral therapy (HAART), body habitus changes occur frequently among HIVinfected patients[1]
Subcutaneous lipoatrophy was observed in HIV-uninfected control men (HIV-)infected patients, even those without clinical evidence of lipodystrophy, compared to age-matched HIV-uninfected men
Despite markedly lower body mass indices (BMI), HIV-infected men with lipodystrophy had a similar amount of visceral adipose tissue (VAT) as HIVuninfected men and tended to have more rapid increases in waist circumference over 6 years of follow-up
Summary
In the era of highly active antiretroviral therapy (HAART), body habitus changes occur frequently among HIVinfected patients[1]. These include lipohypertrophy of the visceral compartment, breasts, and the upper back (dorsocervical fat pad) and subcutaneous lipoatrophy of the trunk, face and extremities. Data from this study indicated that HIV-infected men and women with clinical lipoatrophy had less visceral adipose tissue (VAT) than HIV-uninfected controls[5,6] Another large cross-sectional study described less peripheral fat, but more VAT, in HIV-infected versus HIV-uninfected women, despite similar average body mass indices (BMI) in both groups[7]. Fat abnormalities are common among HIV-infected persons, but few studies have compared regional body fat distribution, including visceral fat, in HIV-infected and HIV-uninfected persons and their subsequent trajectories in body composition over time
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