HIV lipodystrophy: prevalence, severity and correlates of risk in Australia

Abstract

ObjectiveTo establish the prevalence, severity and factors associated with the HIV lipodystrophy syndrome. MethodsCross-sectional study of lipodystrophy conducted in high HIV caseload primary care sites and HIV outpatient clinics. A subset of patients was examined using dual energy X-ray absorptiometry (DEXA) and single cut abdominal computerized tomography (CT) at the L4 vertebral level to quantify regional and total body fat. Factors associated with lipodystrophy, lipoatrophy and lipohypertrophy were assessed using multiple logistic regression based on assignment of cases and non-cases. ResultsOne thousand, three hundred and forty-eight patients (95% male) were surveyed, 20% had AIDS, the mean CD4 lymphocyte count was 486 cells/mL, and 55% had o500 HIV-1 RNA copies/mL. Most participants (87%) had previously received or were currently receiving combination antiretroviral therapy, 73% with at least one protease inhibitor (PI) and 14% a non-PI-containing regimen. Lipodystrophy prevalence was 53% and of these, 55% reported both peripheral lipoatrophy and central lipohypertrophy, 31% experienced peripheral lipoatrophy only and 14% had central lipohypertrophy only. The prevalence of any body habitus change was 62% in PI-experienced patients, 33% in PI-naive patients and 21% in antiretroviral-naive patients. Lipodystrophy severity was less in antiretroviral-naive patients and most severe in PI-experienced patients. Increasing severity of lipodystrophy was both positively and significantly correlated with elevated liver enzymes, decreased testosterone levels, decreased skin-fold thickness, lower levels of total and peripheral fat (DEXA) and higher levels of visceral fat (CT). Lipodystrophy was also significantly associated with increasing age, symptomatic HIV disease, effective viral suppression, and increasing duration of therapy with both nucleoside reverse transcriptase inhibitors and PIs. ConclusionsThe prevalence and severity of lipodystrophy reflects both length and type of treatment with antiretroviral therapy and is associated with decreased testosterone, increases in liver enzymes and greater suppression of HIV RNA. The reports of lipodystrophy in a small percentage of antiretroviralnaive patients suggests that factors other than antiretroviral therapy may be involved in the aetiology of this syndrome or that some conditions, such as wasting or age-associated obesity, may mimic lipoatrophy and lipohypertrophy, respectively.

Early changes in adipokine levels and baseline limb fat may predict HIV lipoatrophy over 2 years following initiation of antiretroviral therapy*

“…The strong, inverse correlations of baseline BMI and body composition parameters such as limb fat, limb fat percentage and VAT with subsequent limb fat loss suggest that individuals with greater pretreatment limb fat are more likely to experience peripheral fat loss, perhaps because such patients have more fat to lose. This finding conflicts somewhat with earlier cross-sectional studies that showed that lipoatrophy was more common in patients who were emaciated [2].…”

“…The strong, inverse correlations of baseline BMI and body composition parameters such as limb fat, limb fat percentage and VAT with subsequent limb fat loss suggest that individuals with greater pretreatment limb fat are more likely to experience peripheral fat loss, perhaps because such patients have more fat to lose. This finding conflicts somewhat with earlier cross-sectional studies that showed that lipoatrophy was more common in patients who were emaciated [2].The association between plasma leptin levels and the development of lipoatrophy was investigated in lipoatrophic HIV-infected males in a nested case-control study (10 cases and 87 controls) from the Swiss HIV Cohort Study. At 2 years, there was no difference in leptin levels between patients who developed clinically assessed lipoatrophy and controls, with age the only predictor of lipoatrophy [19].…”

“…Physical changes are very common [2], and may stigmatize patients and reduce adherence to antiretroviral therapy (ART) [3], while dyslipidaemia and insulin DOI: 10.1111DOI: 10. / j.1468DOI: 10.…”

Lipodystrophy in HIV/AIDS patients with different levels of physical activity while on antiretroviral therapy

“…The prevalence of lipodystrophy in any of the three forms of manifestation (lipoatrophy, lipodystrophy or mixed) is not well established in the literature. The fact that there is no consensus on the diagnostic method and the differences in the studied populations may account for variation between studies [19][20][21][22] . In a review by Tien and Grunfeld 23 , several studies on lipodystrophy were analyzed, which reported that the rates of lipodystrophy range from 30% to 62%.…”

Lipodystrophy in HIV 1-infected patients: lessons for obesity research

“…61,62 Recent studies of adipose tissue biopsies from 'naive' patients have revealed the first signs of mtDNA depletion 63 as well as some impairment of the expression of genes encoding mitochondrial proteins, adipocyte differentiation controllers such as PPARg and proteins specifically related to adipocyte metabolism including adipokines such as adiponectin. 17 This is associated also with increased TNFa gene expression in these patients.…”