Fat Distribution is Altered in HIV-infected Men Without Clinical Evidence of the HIV Lipodystrophy Syndrome

Objective: To determine if fat distribution is altered in HIV-infected men without clinical evidence of lipodystrophy.

Methods: In a cross-sectional design, 14 protease inhibitor (PI)-treated men with lipodystrophy and 12 PI-treated and five PI-naive men without clinical evidence of lipodystrophy underwent body composition and fat distribution analysis by dual-energy X-ray absorptiometry and computed tomography. Their fat distribution was compared to 43 uninfected male controls matched for age and BMI.

Results: The percent of body fat in the trunk of men with HIV lipodystrophy was significantly greater compared to both HIV-infected and healthy controls. The percentage of body fat in the extremities was significantly lower in men with HIV lipodystrophy compared to both HIV-infected and healthy controls. HIV-infected men without clinical evidence of lipodystrophy also had a significantly greater percentage of total body fat in the trunk and a significantly lower percent of body fat in the extremities compared to healthy controls. Among the HIV-infected men, age was an independent predictor of truncal and extremity adiposity.

Conclusion: This study suggests that a continuum of change is present in the adipose organ of HIV-infected men on antiretroviral therapy. Physical examination alone can miss significant changes in body fat distribution in HIV-infected patients.