Original Article
Longitudinal Study of Body Composition of 101 HIV Men With Lipodystrophy: Dual-Energy X-Ray Criteria for Lipodystrophy Evolution

https://doi.org/10.1016/j.jocd.2009.12.004Get rights and content

Abstract

The aim of this study was to define evolution profiles of body composition among human immunodeficiency virus (HIV)-infected men with lipodystrophy. The design is a retrospective analysis using observational data collected longitudinally. We included 101 HIV-infected men with lipodystrophy managed in routine practice and who had 2 dual energy X-ray absorptiometry scans within a minimum interval of 18 mo. Lipodystrophy was defined as a fat mass ratio (FMR, defined as the ratio of the percentage of the trunk fat mass over the percentage of the lower limbs fat mass) equal or superior to 1.5. Patients were classified in “improved” group (IG: increase of lower limbs fat mass ≥ 10%) or “nonimproved” group (NIG). Body composition, immunovirological and epidemiological data were collected and compared between the 2 groups. In the whole population, over a 4-yr period, a significant increase was observed for total fat mass, trunk fat mass, and lower limbs fat mass, whereas total lean mass was stable. Total body mineral density decreased. Fifty-nine patients (IG), less exposed to zidovudine than the NIG, had an increase of lower limbs fat mass higher than 10%. But only 13 (22%) regained a normal distribution of fat mass (FMR < 1.5), showing that lipodystrophy was slowly reversible. Among the NIG, 5 patients (11.9%), less exposed to zidovudine and with a higher mean of viral load, reached an FMR below 1.5. It was mainly because of a loss of trunk fat mass, which could be the sign of a lipodystrophy worsening. Lipodystrophy improved for 58.4% of men. The improvement was very slow. Recovery was observed only in patients with an earlier intervention. No correlation was observed between lipodystrophy and total body bone mineral density. The loss of trunk fat mass without gain of lower limbs fat mass may indicate a worsening of HIV disease.

Section snippets

Background

Dual-energy X-ray absorptiometry (DXA) is a reliable technique for measuring total body and regional bone mineral and soft tissue composition. Its usefulness for evaluating fat redistribution in metabolic diseases and for improving early detection and diagnosis of lipodystrophy has become increasingly evident 1, 2.

Soon after highly active antiretroviral therapy became available, fat redistribution and osteopenia have become 2 major concerns for human immunodeficiency virus (HIV)–treated persons

Study Design

We performed a retrospective analysis using observational data collected longitudinally on HIV-infected men with lipodystrophy. All the patients came from the hospital at Cahors, France and 2 French university hospital outpatient units in Toulouse: the unit of infectious and tropical diseases, Purpan hospital, and the unit of dermatology, La Grave hospital.

Subjects and Groups

All men were older than 18 yr, at steady state, without active opportunistic infection or malignancy and treated for HIV infection before

Results

We included 101 HIV-infected men with lipodystrophy. DXA scans were conducted between June 2001 and June 2007. The mean interval between the 2 DXA scans was 46.4 ± 14.7 mo (median: 51 mo, interquartile range: 34–59).

Discussion

To our knowledge, this study is the longest observation of a large cohort of HIV-infected men with objective criteria of lipodystrophy. The population is homogenous regarding disease history and steady immunovirologic data.

Concerning the whole population, a gain in total fat mass, trunk fat mass, and lower limbs fat mass was observed between the 2 DXA scans. Lipodystrophy improved in 58% of patients, sign of the awareness of physicians regarding this problem. As shown in previous studies, we

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