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Altered Fat Distribution in Men on Reverse Transcriptase Inhibitors (RTIs) K. MULLIGAN*, V. W. TAI, J. C. LO, H. A. ALGREN, D. I. ABRAMS, N. PATTERSON, and M. SCHAMBELAN.
Univ. of California, San Francisco Objective: To determine whether HIV infection per se, antiretroviral (ARV) therapy, or the wasting syndrome uniquely affect regional fat distribution in men.
Methods: Total fat and regional fat distribution (trunk and appendicular [app: arms+legs]) were compared using manual analysis of DEXA scans in HIV- controls (N=44) and 5 groups of HIV+ men: ARV-naïve or limited prior use of RTIs (ARV-; N=28); on nucleoside RTIs (NRTI; N=37) for >6 months; on NRTIs with >10% weight loss (NRTI/wst; N=48); on an NRTI/PI regimen for >6 months but with no clinical evidence of fat redistribution (NRTI/PI/FR-; N=49); and those with central and/or dorsocervical fat accumulation (FA; N=35), all of whom had been on NRTIs and most (>80%) on PIs.
Results: Total body fat and CD4+ lymphocyte count were significantly lower in NRTI/wst but did not differ significantly among the other groups. The trunk/app fat ratio was nearly identical in HIV- and ARV- (1.15±0.05 and 1.16±0.06, respectively). Significantly greater trunk/app fat ratios were noted in NRTI (1.78±0.13), NRTI/PI/FR- (1.71±0.12), and NRTI/wst (1.63±0.10); these values did not differ significantly among these groups. The trunk/app ratio in FA (2.75±0.16) was significantly greater than in the other five groups, primarily as a result of higher truncal fat content.
Conclusion: In men, HIV infection per se had no apparent effect on fat distribution. Despite a decrease in total body fat, patients with wasting had no evidence of a preferential depletion of a specific fat store. Notably, in patients using NRTIs, including those with wasting, the ratio of trunk to appendicular fat was significantly greater than in HIV- and ARV- and was independent of the concomitant use of a PI. Finally, there was no evidence of a trend to either central fat accumulation or appendicular fat loss in patients on PIs who had no complaints or obvious evidence of fat redistribution.
Key Words: DEXA, Fat, Lipodystrophy
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