title: Lipodystrophy defined by Fat Mass Ratio in HIV-infected patients is associated with a high prevalence of glucose disturbances and insulin resistance.
abstract: BACKGROUND
  Combined antiretroviral therapy (cART) in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes.
  
  
  OBJECTIVE
  To compare the prevalence of glucose homeostasis disturbances and IR in HIV patients on cART according to the presence of lipodystrophy (defined clinically and by Fat Mass Ratio) and different patterns of fat distribution and to establish their associations.
  
  
  METHODS
  Cross-sectional cohort study.
  
  
  METHODS
  We evaluated body composition and IR and insulin sensitivity indexes in 345 HIV-infected adults.
  
  
  RESULTS
  Patients with clinical lipodystrophy (CL) had higher plasma glucose levels than patients without CL, without significant differences in plasma insulin levels, A1c, HOMA-IR, HOMA-B, QUICKI, or MATSUDA index. Patients with lipodystrophy defined by FMR had higher plasma glucose and insulin levels, A1c, HOMA-IR, QUICKI and MATSUDA than patients without lipodystrophy, without differences in HOMA-B. Higher insulin resistance (HOMA-IR ≥ 4) was present in patients with FMR-defined lipodystrophy. Patients with FMR-defined lipodystrophy had a higher prevalence of IFG, IGT and DM than patients without lipodystrophy. Significant associations between HOMA-IR and total, central and central/peripheral fat evaluated by CT at abdominal level were found and no association between HOMA-IR and peripheral fat. Association between HOMA-IR and total and trunk fat but no association with leg and arm fat (evaluated by DXA) was found.
  
  
  CONCLUSIONS
  IR and glucose disturbances were significantly increased in patients with FMR-defined lipodystrophy. FMR lipodystrophy definition seems to be a more sensitive determinant of insulin resistance and glucose disturbances than clinical definition.
authors.affiliation: Department of Endocrinology, Hospital de São João, University of Porto Medical School, Alameda Hernâni Monteiro, 4200, Porto, Portugal, Portugal. paula_freitas@sapo.pt
authors.forename: Paula
authors.initials: P
authors.lastname: Freitas
authors.forename: Davide
authors.initials: D
authors.lastname: Carvalho
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Santos
authors.forename: Joana
authors.initials: J
authors.lastname: Mesquita
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Matos
authors.forename: Antonio Jose
authors.initials: AJ
authors.lastname: Madureira
authors.forename: Esteban
authors.initials: E
authors.lastname: Martinez
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
authors.forename: José Luís
authors.initials: JL
authors.lastname: Medina
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001823:Body Composition; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D015658:HIV Infections / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents; D005947:Glucose