Regional body fat distribution in HIV-infected patients with lipodystrophy

Background: Objective criteria for the assessment of patients with lipodystrophy syndrome in human immunodeficiency virus infection (LDHIV) have not emerged. Methods: We compared regional body fat changes in 13 men with severe LDHIV on protease inhibitor-inclusive antiretroviral therapy with 13 control HIV-infected men using anthropometry, dual-energy X-ray absorptionnetry (DEXA), and whole-body magnetic resonance imaging (MRI). Results: LDHIV patients, compared with control subjects, had thinner gluteal, suprailiac, and triceps skinfolds (p <.01) and increased waist circumference (98 +/- 5 cm vs 86 +/- 9 cm, respectively; p =.0008). DEXA studies revealed reduced lower extremity fat (12 +/- 5% vs 22 +/- 9%; p =.0006), increased head and neck fat (18 +/- 3% vs 16 +/- 1 %; p =.01), and increased proportion of total body fat in the trunk (65 +/- 7% vs 53 +/- 8%; p =.0005). MRI analysis revealed reduced thigh fat (12 +/- 5% vs 22 +/- 12%; p =.01), increased dorsocervical fat depth (47 +/- 24 mm vs 19 +/- 7 mm; p=.0009), and nearly significant increase in intra-abdominal fat (218 90 cm(2) VS 157 +/- 70 cm(2); p =.057). Interestingly, control subjects showed a positive relationship between intra-abdominal and dorsocervical fat (r=.57, p =.04), but the LDHIV patients showed a negative relationship (r= -.55, p =.05), suggesting a novel split phenotype among LDHIV patients of either dorsocervical or intraabdominal fat accumulation. Conclusions: We conclude that MRI provides the best tools for definition of LDHIV syndrome and reveals variable phenotypes among LDHIV patients.