title: Fat distribution in HIV-infected patients reporting truncal enlargement quantified by whole-body magnetic resonance imaging.
abstract: BACKGROUND
  Antiretroviral therapy has improved the prospects for people infected with HIV, but some develop a syndrome of profound body habitus and metabolic alterations that include truncal enlargement.
  
  
  OBJECTIVE
  The purpose of this study was to define the body-composition changes associated with this syndrome by using techniques with the power to estimate regional body composition.
  
  
  METHODS
  We compared whole-body and regional skeletal muscle and adipose tissue contents measured by magnetic resonance imaging and dual-energy X-ray absorptiometry (DXA) in 26 HIV-infected patients and 26 matched control subjects. Twelve of the HIV-infected patients had evidence of truncal enlargement.
  
  
  RESULTS
  HIV-infected men and women who noted truncal enlargement had similar amounts of skeletal muscle and subcutaneous adipose tissue but greater visceral adipose tissue than HIV-infected patients without truncal enlargement; these values were larger in men (P < 0.001) than in women (P = 0.08). The ratio of visceral to subcutaneous adipose tissue was greater in both men (P < 0.02) and women (P = 0.05) with truncal enlargement. Two subjects with MRI-confirmed visceral adiposity syndrome (VAS) were not taking protease inhibitors. CD4+ lymphocyte counts were higher (P < 0.001) and plasma viral burdens tended to be lower (P = 0.08) in HIV-infected patients with VAS.
  
  
  CONCLUSIONS
  There was significantly more visceral adipose tissue in the subgroup of HIV-infected patients with truncal enlargement than in those without this sign. VAS occurs in both men and women, is associated with higher CD4+ lymphocyte counts and lower plasma HIV viral burdens, and is not limited to those receiving protease inhibitor therapy.
authors.affiliation: Gastrointestinal Division, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA. eengelson@slrhc.org
authors.forename: E S
authors.initials: ES
authors.lastname: Engelson
authors.forename: D P
authors.initials: DP
authors.lastname: Kotler
authors.forename: Y
authors.initials: Y
authors.lastname: Tan
authors.forename: D
authors.initials: D
authors.lastname: Agin
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: R N
authors.initials: RN
authors.lastname: Pierson
authors.forename: S B
authors.initials: SB
authors.lastname: Heymsfield
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000033:anatomy & histology* / Q000473:pathology; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D001823:Body Composition / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012016:Reference Values; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents