Increased fat accumulation in the liver in HIV-infected patients with antiretroviral therapy-associated lipodystrophy.
OBJECTIVE
To determine liver fat content in patients with highly active antiretroviral therapy (HAART)-associated lipodystrophy.


BACKGROUND
Lipodystrophy in several animal models is associated with fat accumulation in insulin-sensitive tissues, such as the liver. This causes hyperinsulinaemia, dyslipidaemia and other features of insulin resistance.


METHODS
A cross-sectional study.


METHODS
Three age- and weight-matched groups were compared: 25 HIV-positive men with HAART-associated lipodystrophy (HAART+LD+), nine HIV-positive men receiving HAART, but without lipodystrophy (HAART+LD-), and 35 HIV-negative healthy men (HIV-). Liver fat content was measured using proton spectroscopy. Intra-abdominal and subcutaneous fat were determined using magnetic resonance imaging.


RESULTS
Liver fat content was significantly higher in the HAART+LD+ (8 +/- 10%) than the HIV- (5 +/- 7%; P < 0.05) or the HAART+LD- (3 +/- 5%; P < 0.01) group. Liver fat content correlated with serum fasting insulin in the HAART+LD+ (r = 0.47; P < 0.05) and HIV- groups (r = 0.65; < 0.001), but not with the amount of intra-abdominal fat. Within the HAART+LD+ group, serum insulin did not correlate with the amount of intra-abdominal fat. The HAART+LD+ group had a lower serum leptin concentration when compared to the two other groups. Features of insulin resistance, including hepatic fat accumulation, were not found in HAART+LD-group.


CONCLUSIONS
The severity of the insulin resistance syndrome in patients with HAART-associated lipodystrophy is related to the extent of fat accumulation in the liver rather than in the intra-abdominal region. Fat accumulation in the liver may therefore play a causative role in the development of insulin resistance in these patients.
Sutinen
Jussi
J
Department of Medicine, Division of Diabetes, Helsinki University Central Hospital, Finland.
Häkkinen
Anna-Maija
AM
Westerbacka
Jukka
J
Seppälä-Lindroos
Anneli
A
Vehkavaara
Satu
S
Halavaara
Juha
J
Järvinen
Asko
A
Ristola
Matti
M
Yki-Järvinen
Hannele
H
D000273:Adipose Tissue / Q000378:metabolism*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000209:etiology / Q000378:metabolism*; D006801:Humans; D008099:Liver / Q000378:metabolism*; D008297:Male; D011522:Protons; D013057:Spectrum Analysis
D011522:Protons