Fat distribution in men with HIV infection

Abstract

Objective: Both peripheral fat loss and central fat gain have been reported in HIV infection. Which changes are specific to HIV were determined by comparison with control subjects and the associations among different adipose tissue depots were determined.

Methods: Cross-sectional analysis of HIV-positive and control men from the study of Fat Redistribution and Metabolic Change in HIV Infection. Lipoatrophy or lipohypertrophy was defined as concordance between participant report of change and examination. Regional adipose tissue volume was measured by magnetic resonance imaging (MRI).

Results: HIV-positive men reported more fat loss than controls in all peripheral and most central depots. Peripheral lipoatrophy was more frequent in HIV-positive men than in controls (38.3% vs. 4.6%, P < 0.001), whereas central lipohypertrophy was less frequent (40.2% vs. 55.9%, P = 0.001). Among HIV-positive men, the presence of central lipohypertrophy was not positively associated with peripheral lipoatrophy (odds ratio = 0.71, CI: 0.47 to 1.06, P = 0.10). On MRI, HIV-positive men with clinical peripheral lipoatrophy had less subcutaneous adipose tissue (SAT) in peripheral and central sites and less visceral adipose tissue (VAT) than HIV-positive men without peripheral lipoatrophy. HIV-positive men both with and without lipoatrophy had less SAT than controls, with legs and lower trunk more affected than upper trunk. Use of the antiretroviral drugs stavudine or indinavir was associated with less leg SAT but did not appear to be associated with more VAT; nevirapine use was associated with less VAT.

Conclusion: Both peripheral and central subcutaneous lipoatrophy was found in HIV infection. Lipoatrophy in HIV-positive men is not associated with reciprocally increased VAT.

FIGURE 1

Prevalence of self-report of change in body fat over the prior 5 years. HIV-infected men (solid bars) and control subjects (open bars) were surveyed for self-reported changes in fat in multiple anatomic areas and in waist size that occurred in the 5 years prior to study. A, Decreased fat. B, Increased fat.

FIGURE 2

A, Prevalence of lipoatrophy by concordance. Subjects who reported loss of fat and had less fat than normal on examination were designated as having clinical lipoatrophy. B, Prevalence of lipohypertrophy by concordance. Subjects who reported gain of fat and had more fat than normal on examination were designated as having clinical lipohypertrophy. HIV-infected (solid bars); control subjects (open bars).

FIGURE 3

Prevalence of lipoatrophy (A and B) and lipohypertrophy (C and D) by number of anatomic sites affected in HIV-infected (closed bars) and control subjects (open bars). The percentage of subjects with each number of anatomic sites affected is presented. A and D, Peripheral sites (cheeks, face, arms, buttocks, leg). B and C, Central Sites (neck, chest, upper back, waist, abdominal fat).

FIGURE 4

Adipose tissue volume by MRI. Comparison of control subjects, HIV-infected with clinical peripheral lipoatrophy (LA+) and HIV-infected without clinical peripheral lipoatrophy (LA−). Adipose tissue volume was divided by height squared, medians and confidence intervals were calculated, and these were then multiplied by 1.75² to correspond to a typical height. Values are median and confidence interval. Leg is the region from the toes to the slice in which the leg separation is visible and no pubic bone occurs. Lower trunk is the region from the slice above legs to the last slice where the liver area is greater than lung. Upper trunk is the region from the first slice where the lung area is greater than liver to the slice below the one where the arms are separated from torso. Arm is defined as the first slice where the arms are separated from torso to the end of the hands.

FIGURE 5

Comparison of MRI findings in HIV subjects with and without clinical lipoatrophy vs. control subjects: Results of multivariate models adjusting for non–HIV-related factors affecting adipose tissue volume in various fat depots. Percentage effects in HIV-infected groups vs. controls are estimated in multivariate models of logarithmically transformed (adipose tissue by MRI), controlling for logarithm (lean mass) and the square of log (lean mass) (continuous), age (continuous), ethnicity, total physical activity score (categorical by quartile), smoking (current vs. past vs. never), current marijuana use (used 10+ days per month vs. 1–9 days vs. not used), current use of cocaine (crack or other forms, 10+ days per month vs. 1–9 days vs. not used), heroin use (any in past 30 days vs. past use only vs. never used), speed use (any in past 30 days vs. past use only vs. never used), and reported adequacy of food eaten (enough vs. less). Hatched bars: HIV-infected with lipoatrophy (LA+); open bars: HIV-infected no lipoatrophy (LA−). P values are vs. controls.

FIGURE 6

Clinical peripheral lipoatrophy is not associated with central lipohypertrophy. The prevalence of peripheral lipoatrophy is presented on the y-axis for those with (closed bars) or without (open bars) central lipohypertrophy (left side) or central lipoatrophy (right side).