Regional adipose tissue measured by MRI over 5 years in HIV-infected and control participants indicates persistence of HIV-associated lipoatrophy.
OBJECTIVE
Peripheral fat loss and visceral fat gain have been reported in HIV infection. There are limited data on long-term change in adipose tissue in HIV-infected patients vs. controls. Therefore, we determined change in regional adipose tissue from baseline examination to 5 years later among participants in the study of Fat Redistribution and Metabolic Change in HIV Infection.


METHODS
Regional adipose tissue volume was measured using MRI at both examinations in 477 HIV-infected and 214 control men and women. Lipoatrophy was defined as leg subcutaneous adipose tissue (SAT) below the cutoff point marking the lowest decile (10%) of controls at each examination.


RESULTS
HIV-infected and control participants showed similar adipose tissue gains. In men, all SAT depots and visceral adipose tissue started lower and remained lower on average in HIV-infected vs. controls. In women, leg and arm SAT also started lower and remained lower in HIV-infected vs. controls. Mean leg SAT of HIV-infected men was 67% of control men at baseline and 65% at follow-up; for women 83% and 77%. At baseline, 48% of HIV-infected participants had lipoatrophy; on average those with baseline lipoatrophy gained 0.96L of leg SAT compared with 1.23L gain for controls in the lowest decile (P = 0.16). At follow-up, 53% of HIV-infected participants had lipoatrophy. In multivariable models, discontinuation of stavudine appeared to produce little gain in leg SAT ( approximately 1.1%/year).


CONCLUSIONS
HIV-infected participants did not substantially recover SAT compared with controls, although both showed average gains. HIV-associated lipoatrophy persisted after 5 years of follow-up.
Grunfeld
Carl
C
Office of the Principal Investigator, The FRAM Study, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, USA. carl.grunfeld@ucsf.edu
Saag
Michael
M
Cofrancesco
Joseph
J
Lewis
Cora Elizabeth
CE
Kronmal
Richard
R
Heymsfield
Steven
S
Tien
Phyllis C
PC
Bacchetti
Peter
P
Shlipak
Michael
M
Scherzer
Rebecca
R
D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects; D001823:Body Composition; D050218:Body Fat Distribution; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000473:pathology*; D006801:Humans; D007866:Leg / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects; D050151:Subcutaneous Fat / Q000473:pathology
D019380:Anti-HIV Agents; D018119:Stavudine