Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1-infected men starting therapy.
OBJECTIVE
Little prospective data are published on the natural history of HIV-associated lipodystrophy (HIVLD) in individuals beginning their first antiretroviral regimen. To investigate this a study was designed to explore changes in body composition occurring with antiretroviral therapy.


METHODS
A non-randomized, prospective, exploratory study of 40, HIV-infected men, naive to treatment, beginning antiretroviral therapy. Regular assessments of body composition, and metabolic and immunological parameters were performed.


RESULTS
Mean follow-up was 96 (SD 45) weeks of therapy. There were increases in limb fat, central abdominal fat and lean mass over the initial 24 weeks of therapy followed by a selective, progressive loss of limb fat from week 24. There was a median 13.6% [interquartile range (IQR), 0.9-26.3] loss of limb fat per year from week 24 onwards. Treatment with stavudine, higher baseline HIV RNA, higher baseline 'T' score and lower week 24 lean mass were associated with higher rate of limb fat loss from week 24. In multivariate analysis, treatment with stavudine was the strongest independent factor associated with rate of limb fat loss (P = 0.05). Hypercholesterolaemia developed early in treatment, whereas hypertriglyceridaemia, hyperinsulinaemia and decreased bone mineral density developed later. The largest changes in CD4 cell counts and HIV viral load, seen early into treatment, were associated with gain rather than loss of fat.


CONCLUSIONS
This is the first prospective study demonstrating that treatment with antiretrovirals results in progressive, selective loss of limb fat. Loss of limb fat occurred after the period of most intense immune restoration, making an immune aetiology unlikely.
Mallon
Patrick W
PW
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia. Pmallon@nchecr.unsw.edu.au
Miller
John
J
Cooper
David A
DA
Carr
Andrew
A
D000273:Adipose Tissue; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001823:Body Composition; D015519:Bone Density; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000378:metabolism; D006801:Humans; D008297:Male; D011446:Prospective Studies
D008078:Cholesterol, LDL