Regional adipose tissue and lipid and lipoprotein levels in HIV-infected women

Abstract

Background: HIV infection and antiretroviral therapy are associated with dyslipidemia, but the association between regional body fat and lipid levels is not well described.

Methods: Multivariable linear regression analyzed the association between magnetic resonance imaging-measured regional adipose tissue and fasting lipids in 284 HIV-infected and 129 control women.

Results: Among African Americans, HIV-infected women had higher triglyceride (116 vs. 83 mg/dL; P < 0.001), similar high-density lipoprotein (HDL; 52 vs. 50 mg/dL; P = 0.60), and lower low-density lipoprotein (LDL; 99 vs. 118 mg/dL; P = 0.008) levels than controls. Among whites, HIV-infected women had higher triglyceride (141 vs. 78 mg/dL; P < 0.001), lower HDL (46 vs. 57 mg/dL; P < 0.001), and slightly lower LDL (100 vs. 107 mg/dL; P = 0.059) levels than controls. After adjustment for demographic and lifestyle factors, the highest tertile of visceral adipose tissue (VAT) was associated with higher triglyceride (+85%, 95% confidence interval [CI]: 55 to 121) and lower HDL (-9%, 95% CI: -18 to 0) levels in HIV-infected women; the highest tertile of leg subcutaneous adipose tissue (SAT) was associated with lower triglyceride levels in HIV-infected women (-28%, 95% CI: -41 to -11) and controls (-39%, 95% CI: -5 to -18). After further adjustment for adipose tissue, HIV infection remained associated with higher triglyceride (+40%, 95% CI: 21 to 63) and lower LDL (-17%, 95% CI: -26 to -8) levels, whereas HIV infection remained associated with lower HDL levels (-21%, 95% CI: -29 to -12) in whites but not in African Americans (+8%, 95% CI: -2 to 19).

Conclusions: HIV-infected white women are more likely to have proatherogenic lipid profiles than HIV-infected African American women. Less leg SAT and more VAT are important factors associated with adverse lipid levels. HIV-infected women may be at particular risk for dyslipidemia because of the risk for HIV-associated lipoatrophy.

FIGURE 1

A, Lipid and lipoprotein levels stratified by HIV status. B, Lipid and lipoprotein levels in African American women stratified by HIV status. C, Lipid and lipoprotein levels in white women stratified by HIV status.

FIGURE 2

Multivariable association of regional adipose tissue with lipid and lipoprotein levels in HIV-infected and control women (not age-restricted). Triglycerides (A), LDL-C (B), and HDL-C (C). Analyses also control for demographic and lifestyle factors and include all HIV-infected women. Italicized depots did not reach statistical significance and were not included in the model but are shown to facilitate comparison. Levels are in mg/dL. ◇ corresponds to the first tertile or lowest amount of fat; ■ corresponds to the second tertile; ▲ corresponds to the third tertile or highest amount of fat. Asterisks denote comparison with first tertile: *P < 0.05, **P < 0.01, ***P < 0.001.