title: Human immunodeficiency virus-associated lipodystrophy: an objective definition based on dual-energy x-ray absorptiometry-derived regional fat ratios in a South Asian population.
abstract: OBJECTIVE
  To develop an objective definition of human immunodeficiency virus (HIV)-associated lipodystrophy by using regional fat mass ratios and to assess the utility of anthropometric and skinfold measurements in the initial screening for lipodystrophy.
  
  
  METHODS
  Male patients between 25 and 50 years old with proven HIV infection (highly active antiretroviral therapy [HAART]-naïve subjects and those receiving successful HAART) were studied and compared with body mass index (BMI)-matched HIV-negative control subjects. Anthropometric variables, body composition, dual-energy x-ray absorptiometry findings, and metabolic variables were compared among the 3 study groups and between those patients with and those without lipodystrophy.
  
  
  RESULTS
  Trunk fat/lower limb fat mass ratio >2.28 identified 54.3% of patients with HIV receiving HAART as having lipodystrophy and had the highest odds ratio for predicting metabolic syndrome. The "clinical diagnosis of lipodystrophy" and the "clinical scoring system" had too many false-positive and false-negative results. Triceps skinfold thickness (SFT)/BMI ratio ≤0.49 and abdominal SFT/triceps SFT ratio >1.385 have good sensitivity but poor specificity in identifying lipodystrophy. In comparison with HAART-naïve patients with HIV, those receiving HAART had significantly higher insulin resistance, and a significantly greater proportion had impaired glucose tolerance and dyslipidemia. Among patients receiving HAART, those with lipodystrophy had a greater degree of insulin resistance, higher triglyceride levels, and lower levels of high-density lipoprotein cholesterol.
  
  
  CONCLUSIONS
  The trunk fat/lower limb fat mass ratio in BMI-matched normal subjects can be used to derive cutoff values to define lipodystrophy objectively in HIV-infected patients. Defining lipodystrophy in this way is better than other methods of identifying those patients with increased cardiovascular risk. Triceps SFT/BMI and abdominal SFT/triceps SFT ratios may be useful as screening tools in resource-poor settings.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India. hsasha_75@yahoo.co.in
authors.forename: Hesarghatta Shyamasunder
authors.initials: HS
authors.lastname: Asha
authors.forename: Mandalam Subramaniam
authors.initials: MS
authors.lastname: Seshadri
authors.forename: Thomas Vizhalil
authors.initials: TV
authors.lastname: Paul
authors.forename: Ooriapadickal Cherian
authors.initials: OC
authors.lastname: Abraham
authors.forename: Priscilla
authors.initials: P
authors.lastname: Rupali
authors.forename: Nihal
authors.initials: N
authors.lastname: Thomas
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology; D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology; D050154:Adiposity / Q000208:ethnology; D000328:Adult; D000554:Ambulatory Care Facilities; D000886:Anthropometry; D001132:Arm; D001208:Asia; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000473:pathology; D006801:Humans; D007194:India; D007333:Insulin Resistance; D035002:Lower Extremity; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012885:Skinfold Thickness