A prospective study of body fat redistribution, lipid, and glucose parameters in HIV-infected patients initiating combination antiretroviral therapy.
OBJECTIVE
To prospectively determine incidence, prevalence, and extent of lipodystrophy (LD) and associated metabolic changes.


METHODS
This was a prospective cohort study. Body habitus changes were determined by anthropometrics, photography, and regional dual-energy X-ray absorptiometry (DXA) scan. Metabolic parameters included triglyceride (TG), total (TC), LDL and HDL cholesterol, glucose, and insulin.


RESULTS
68 patients were included. 51 (75%) received protease inhibitor (PI)-based and 17 (25%) non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ARV) and 90% a thymidine analogue. Statistically significant increases in TC, TG, LDL, and HDL by 12 months developed on PI but only in TC for NNRTI. At 24 months, on DXA scanning, there were no statistically significant changes in median limb or total body fat on NNRTI but a statistically significant decrease in limb fat on PI (p = .01). There was considerable individual variation with overall 3 (7%) patients having >20% increases and 16 (36%) with >20% decreases in limb fat and 6 (14%) having >20% increases and 7 (16%) with >20% decreases in total body fat.


CONCLUSIONS
Lipid changes occurred early and progressed. Median changes in body fat were minor and more common on PI, but individual variation in change was large, challenging the use of medians or threshold changes to predict impact of different ARV agents.
Walmsley
Sharon
S
Department of Medicine, University Health Network, Toronto, Ontario, Canada. Sharon.walmsley@uhn.on.ca
Cheung
Angela M
AM
Fantus
George
G
Gough
Kevin
K
Smaill
Fiona
F
Azad
Diong
Christina
C
Raboud
Janet
J
D000273:Adipose Tissue / Q000187:drug effects*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects*; D001823:Body Composition / Q000187:drug effects; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies
D044966:Anti-Retroviral Agents; D001786:Blood Glucose; D008055:Lipids