FRAM Results: Central Lipohypertrophy Not Associated With Peripheral Lipoatrophy

[Guest guest]

FRAM Results: Central Lipohypertrophy Not Associated With Peripheral Lipoatrophy in HIV-Infected Women

Posting Date: November 08, 2006

Fat Redistribution and Metabolic Change in HIV Infection (FRAM): cross-sectional study

Summary of Key Conclusions

Peripheral lipoatrophy more common in HIV-infected women vs uninfected women

28% of HIV-infected women experienced peripheral lipoatrophy HIV-infected women had significantly less subcutaneous adipose tissue (SAT) in most peripheral anatomic sites vs controls

Central lipohypertrophy not associated with peripheral lipoatrophy in HIV-infected women Use of stavudine and any NNRTI associated with significantly less leg SAT HAART associated with significantly greater visceral adipose tissue (VAT)

Background

Fat distribution changes (both fat loss and fat gain) associated with HIV infection

Potential for increased risk of cardiovascular disease Previous studies suggest fat distribution changes more prevalent in HIV-infected women than men

No consensus definition of fat distribution changes in HIV-infected patients

Better understanding of the relationships between fat changes needed before definition possible

Current study examined body fat changes and factors associated with fat distribution in HIV-infected and control women

SAT and VAT measured by self-report, clinical examination, and magnetic resonance imaging

Summary of Study Design

183 HIV-infected women from 16 HIV or infectious disease clinics evaluated

Data compared with 142 healthy women from Coronary Artery Risk Development in Young Adults (CARDIA) study

HIV-infected individuals and controls administered standardized questionnaires

Individuals reported on severity of fat changes at varying peripheral and central anatomical sites over the last 5 years Questionnaire reports verified by physical examinations administered by trained associates

Clinical lipoatrophy defined as fat loss reported by individual and confirmed by physical examination Clinical lipohypertrophy defined as fat gain reported by individual and confirmed by physical examination Adipose tissue volume determined by magnetic resonance imaging

Normalized by dividing by patient’s height squared and transforming to 1.75 m of the patient’s height

P values calculated by Fisher’s exact test Multivariate analyses conducted to determine factors associated with lipodystrophy

Adjusted for age, race, smoking, alcohol use, illicit drug use, food intake, and physical activity

Baseline Characteristics

Lower median age, weight, and height for HIV-infected women

Control and HIV-infected women had similar body mass index

Characteristic

HIV-Infected Women(n = 183)

Uninfected Women(n = 142)

P Value

Median age, yrs (range)

39(33-45)

42(33-45)

< .001

Median height, cm (range)

162.6(142.5-185.6)

164.5(149.9-192.0)

..005

Median weight, kg (range)

71.7(32.7-140.2)

75.1(42.9-117.7)

..017

Median BMI, kg/m2 (range)

26.4(13.0-47.7)

28.0(17.5-47.8)

..160

Race, %

White

32

49

..002

Black

56

51

..370

Hispanic

10

0

Premenopausal, %

80

81

> .990

BMI, body mass index.

Main Findings

Clinical peripheral lipoatrophy more common, clinical peripheral lipohypertrophy less common in HIV-infected women vs uninfected controls

Significantly more HIV-infected women reported fat loss and significantly fewer reported fat gain over the last 5 years in all peripheral sites (cheeks, face, arms, buttocks, legs; all P < .001)

Low incidence of central lipoatrophy and high incidence of central lipohypertrophy in both HIV-infected and uninfected women

Lipodystrophy at ≥ 1 Site, %

HIV-Infected Women(n = 183)

Uninfected Women(n = 142)

P Value

Peripheral

Lipoatrophy

28

4

< .001

Lipohypertrophy

35

62

< .001

Central

Lipoatrophy

6

3

..44

Lipohypertrophy

62

63

..91

Comparison of HIV-infected women with clinical peripheral lipoatrophy vs HIV-infected women without clinical peripheral lipoatrophy revealed that women with lipoatrophy had

Less VAT (P = .014) Less leg SAT (P < .001) Less lower trunk SAT (P < .001) Less arm SAT (P < .001) Less upper trunk SAT (P = .001)

Significantly lower leg SAT in HIV-infected women with and without lipoatrophy vs controls Presence of central lipohypertrophy associated with lack of clinical peripheral lipoatrophy in HIV-infected women (odds ratio: 0.39; 95% confidence interval (CI): 0.20-0.75; P = .006)

All women with central lipoatrophy had peripheral lipoatrophy

Other Outcomes

In multivariate analyses, regimens containing stavudine or an NNRTI significantly associated with decreased leg SAT in HIV-infected women

Older age and receipt of HAART associated with increased VAT

HIV- and Non-HIV–Related Factors*

Effect on Leg SAT, %(95% CI)†

P Value

Effect on VAT, %(95% CI)†

P Value

Race (black vs white)

44(23 to 72)

< .0001

-21(-38 to 2)

..089

Age (yrs/decade)

-6(-14 to 2)

..130

18(2 to 35)

..031

Smoker vs nonsmoker

-10(-23 to 7)

..260

-32(-47 to -11)

< .0001

HIV-1 RNA (log10 copies/mL)

-2(-11 to 7)

..580

-2(-17 to 15)

..840

Stavudine (per yr of use)

-9(-12 to -5)

< .0001

1(-5 to 7)

..780

NNRTI (per yr of use)

-6(-12 to -1)

< .027

0(-9 to 8)

..880

HAART (per yr of use)

-0.6(-5.0 to 4.0)

..830

7(1 to 3)

..033

*Bootstrapped outcome for the antiretrovirals and HIV- and non-HIV–related factors.†Estimate of percentage differences in adipose tissue caused by the factor normalized by height.

Reference

Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). Fat distribution in women with HIV infection. J Acquir Immune Defic Syndr. 2006;42:562-571.

Link to the original abstract.

Regards, Vergelpowerusa dot org"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - Ruskin