title: Changes in Body Fat Distribution on Dual-Energy X-Ray Absorptiometry in Black South Africans Starting First-Line Antiretroviral Therapy.
abstract: Long-term use of antiretroviral therapy (ART) increases the risk of developing lipodystrophy. Few studies from Africa have used longitudinal data to assess the development of lipoatrophy and lipohypertrophy. We use clinical anthropometry and dual-energy X-ray absorptiometry (DEXA) to describe changes in body fat distribution over a 24-month period in individuals initiated on ART. A convenience sample of black South Africans (55 men and 132 women) were recruited and followed for 24 months after commencing ART. Body fat distribution was assessed using anthropometric measurements and DEXA scans at baseline and then at 3, 6, 12, 18, and 24 months after commencing ART. DEXA was also used to estimate abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Women gained more overall weight and more regional fat in all areas analyzed on DEXA scans. Women, not men, experienced a significant increasing trend in trunk fat and a significant decreasing trend in limb fat, when expressed as a percentage of total body fat. In men, the risk of developing lipoatrophy was more than two times greater than that of women, after adjusting for age, baseline body mass index, and ART regimen. Lipohypertrophy occurred similarly in men and women. VAT and SAT increased significantly in men and women, with women gaining considerably more than men. These findings are of great concern as an increased waist circumference is associated with increased mortality in HIV-infected populations. Further investigation is required to understand the mechanisms underlying the sex differences in changes in body fat distribution and its effects on cardiovascular risk.
authors.affiliation: 1 Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town , Cape Town, South Africa .
authors.forename: Zulfa
authors.initials: Z
authors.lastname: Abrahams
authors.affiliation: 1 Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town , Cape Town, South Africa .
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
authors.affiliation: 2 Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa .
authors.forename: Maia
authors.initials: M
authors.lastname: Lesosky
authors.affiliation: 3 Division of Clinical Pharmacology, Department of Medicine, University of Cape Town , Cape Town, South Africa .
authors.forename: Gary
authors.initials: G
authors.lastname: Maartens
authors.affiliation: 1 Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town , Cape Town, South Africa .
authors.forename: Joel
authors.initials: J
authors.lastname: Dave
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D044383:Black People / Q000706:statistics & numerical data; D050218:Body Fat Distribution; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D050152:Intra-Abdominal Fat / Q000187:drug effects*; D008060:Lipodystrophy / Q000139:chemically induced* / Q000150:complications; D008297:Male; D012307:Risk Factors
keywords: ART; DEXA; lipoatrophy; lipodystrophy; lipohypertrophy