title: A prospective study of body fat redistribution, lipid, and glucose parameters in HIV-infected patients initiating combination antiretroviral therapy.
abstract: 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.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ontario, Canada. Sharon.walmsley@uhn.on.ca
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: George
authors.initials: G
authors.lastname: Fantus
authors.forename: Kevin
authors.initials: K
authors.lastname: Gough
authors.forename: Fiona
authors.initials: F
authors.lastname: Smaill
authors.lastname: Azad
authors.forename: Christina
authors.initials: C
authors.lastname: Diong
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents; D001786:Blood Glucose; D008055:Lipids