Lower serum adiponectin level is associated with lipodystrophy among HIV-infected men in the Study toUnderstand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) study.

Abstract

Adiponectin levels are inversely related to cardiovascular risk and are low in diabetics and obese persons. We examined the association between adiponectin concentration and HIV-associated lipodystrophy, which remains unclear. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) was a prospective cohort study of HIV-infected adults conducted in four US cities. Lean body and fat masses were assessed using dual-energy X-ray absorptiometry scans. Using baseline data from 2004 to 2006, we defined lipodystrophy using a sex-specific fat mass ratio and performed cross-sectional analyses of associated risks using multivariable logistic regression. Among 440 male participants (median age 42years; 68% non-Hispanic white; 88% prescribed combination antiretroviral therapy; median CD4 lymphocyte count 468 cells/μL; 76% with viral load <400 HIV-1 RNA copies/mL; 5% diabetic; median body mass index 25kg/m2 ), median concentrations of leptin and adiponectin were 3.04ng/L [interquartile range (IQR) 1.77-5.43 ng/L] and 8005μg/mL (IQR 4950-11935 μg/mL), respectively. The prevalence of lipodystrophy was 14%. Lipodystrophy was significantly associated with increasing age [prevalence ratio (PR) 1.50; 95% confidence interval (CI) 1.10-2.06, per 10years], adiponectin <8005μg/mL (PR 5.02; 95% CI 2.53-9.95), ever stavudine use (PR 2.26; 95% CI 1.36-3.75), CD4 cell count >500 cells/μL (PR 2.59; 95% CI 1.46-4.61), viral load <400 copies/mL (PR 3.98; 95% CI 1.25-12.6), highly sensitive C-reactive protein <1.61mg/L (PR 1.91; 95% CI 1.11-3.28) and smoking (PR 0.42; 95% CI 0.22-0.78). Among men in this HIV-infected cohort, the prevalence of lipodystrophy was similar to previous estimates for persons living with HIV, and was associated with lower adiponectin levels, potentially indicating increased cardiovascular disease risk.