title: The natural history of HIV-associated lipodystrophy in the changing scenario of HIV infection.
abstract: OBJECTIVE
  In long-term HIV-infected patients, peripheral lipoatrophy (LA) and central lipohypertrophy (LH) appear to be related to the same insults (virus and antiretroviral drugs), but are likely to be associated with different fat depot physiologies. The objective of this study was to describe the natural history of lipodystrophy assessed using dual energy X-ray absorptiometry (DEXA) and computed tomography (CT) in a large HIV out-patients metabolic clinic.
  
  
  METHODS
  An observational retrospective study was carried out including HIV-infected patients recruited at the Metabolic Clinic of Modena, Modena, Italy, who were assessed for lipodystrophy and had at least two anthropometric evaluations using DEXA for leg fat per cent mass and abdominal CT for visceral adipose tissue (VAT). Factors associated with leg fat per cent and VAT changes were analysed using multivariable generalized estimating equation (GEE) regression models.
  
  
  RESULTS
  A total of 6789 DEXAs and 7566 CT scans were evaluated in the observation period. A total of 1840 patients were included; the mean age was 45.2 ± 7.2 (standard deviation) years, 621 (34%) were women, and the median HIV infection duration was 176 (interquartile range 121-232) years. According to the GEE multivariable regression analysis, leg fat per cent evaluated with DEXA appeared to increase over calendar years (ß = 0.92; P < 0.001); moreover, a progressive increase in VAT was observed in the cohort (ß = 5.69; P < 0.001). No association with antiretroviral drugs was found.
  
  
  CONCLUSIONS
  In our study, neither LA nor LH appeared to be associated with antiretroviral drug exposure. We observed a progressive increase in LH in HIV-infected patients over calendar years. This anthropometric change, together with loss of appendicular lean mass, could describe a physiological aging process in HIV-infected patients.
authors.affiliation: Infectious Diseases Clinics, Policlinico University Hospital, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Guaraldi
authors.forename: C
authors.initials: C
authors.lastname: Stentarelli
authors.forename: S
authors.initials: S
authors.lastname: Zona
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.forename: B
authors.initials: B
authors.lastname: Beghetto
authors.forename: F
authors.initials: F
authors.lastname: Carli
authors.forename: G
authors.initials: G
authors.lastname: Orlando
authors.forename: A
authors.initials: A
authors.lastname: Franceschetto
authors.forename: A
authors.initials: A
authors.lastname: Casolo
authors.forename: C
authors.initials: C
authors.lastname: Mussini
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D001823:Body Composition / Q000187:drug effects; D050218:Body Fat Distribution; D015992:Body Mass Index; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000503:physiopathology*; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D007558:Italy; D007866:Leg; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055105:Waist Circumference
chemical_list: D044966:Anti-Retroviral Agents
keywords: antropometry; body composition; body fat changes; lipoatrophy; lipodystrophy; lipohypetrophy