Background:  HIV-associated lipodystrophy is characterized by wasting of subcutaneous fat, and the accumulation of visceral, chest, and/or dorso-cervical fat, with or without metabolic derangements. In the subset designated as HARS the accumulation of visceral adipose tissue (VAT) may constitute a risk for cardiovascular disease and type II diabetes, and lead to local symptoms and dissatisfaction with antiviral. For a controlled study of growth hormone to reduce VAT in HARS a key issue has been to devise a simple, effective means to select study-eligible patients with HARS, emphasizing VAT accumulation and not simple obesity. A previous discriminant function based on waist (WC) and hip (HC) circumference and the ratio WC:HC (WHR) was specific and sensitive in detection of clinically diagnosed HARS. Here we demonstrate that use of similar anthropometric criteria to select HARS patients defines a group radiologically distinct from healthy controls (C).

Methods: 31 M and 11 F HIV+ adults met the eligibility criteria:  WC > 88.2 cm (male); 75.3 (female) and WHR ≥0.95 (male); 0.9 (female), and were compared with 300 C (128 male 172 female). VAT and Subcutaneous AT (SAT) are expressed as cross-sectional areas on CT or MRI (C) scans at the L4-5 level.

Results (mean±SD, p values for t-test):

	BMI (kg.m-2)	SAT (cm2)	VAT (cm2)
	Male           Female FEMALE	Male            Female	Male            Female
Pts	26.9±2.7   26.6±4.8	176.6±88  282.9±118	196.4±99  110.4±37
C	25.5±3.8   25.4±5.3	166.1±90  231.4±137	73.3±60     56.2±49
p	ns                ns	ns               ns	<0.001         <0.001

The 95% confidence bounds of VAT in HARS patients thus selected can be used to distinguish patients from C with a specificity of 94% for males and 85% for females.

Conclusions: use of WC and WHR criteria applied to HIV+ patients selects a population of marginally higher BMI and SAT than C but whose VAT is 2-3 x greater than C. Thus, the criteria define a population suitable for entry into a therapeutic trial for patients with HARS with specific large increases in VAT, rather than nonspecific obesity.