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Comparison of Abdominal Fat Distribution in HIV+ Patients, with and without Clinical Fat Redistribution and HIV- Patients, Using Computed Tomography (CT) P. BURN, S. COMITIS, G. MOYLE*, Y. MIAO, C. BALDWIN, S. MANDALIA, S. PADLEY, and B. GAZZARD.
Chelsea and Westminster Hosp., London, UK Background: Visceral abdominal fat accumulation and subcutaneous fat loss have been reported during antiretroviral therapy. Standardised assessments for this condition are not established.
Methods: The distribution of subcutaneous (SAT), visceral (VAT), total (TAT) fat, and VAT:TAT ratio in four groups of patients was assessed by single slice CT scan through the umbilicus. The HIV+ patients consisted of 3 groups: clinical fat redistribution syndrome taking protease inhibitors (HIVPI), fat redistribution syndrome on PI-sparing therapy (HIVoPI) and therapy naive patients without fat redistribution syndrome (HIVn). The control group comprised general radiology patients with previously normal CT examination and no significant medical disorder.
Results: Patients were well matched for age (mean range 37.9-48.6yrs). For HIVPI, HIVoPI and HIVn, median CD4/mm3 (range) were 400 (134-528), 363.5 (211-545) and 65 (19-89), and Log10 viral load((sd) cps/ml)1.32 (0.713), 1.74 (1.02), and 5.30 (0.76), respectively. Adipose tissue results expressed as a mean (95% confidence intervals in brackets below), or as a median (†) and inter quartile range as appropriate; p-values by Kruskal-Wallis test.
For HIVPI (n=19) HIVoPI (n=7), HIVn (n=12) and Control (n=14) values are SAT(cm2)† 65.6(26-122), 72.9(45-142), 62.8(34-94), 155.3(111-204), for VAT(cm2) 139.4(111-168), 161.5(101-222), 49.3(32-67), 102.7(69-137), for TAT(cm2) 220.3(172-269), 245.8(169-322), 128.5(68-189), 260.7(208-314)and for VAT:TAT 0.66(0.58-0.75), 0.66(0.51-0.80), 0.44(0.33-0.56) and 0.37(0.29-0.45), respectively. Significant differences were observed between SAT, VAT, TAT and VAT/TAT between the four groups of patients ( p=0.0011, 0.0001, 0.0064 and 0.0001 respectively). HIV patient groups on- therapy with clinical both had a significantly higher VAT:TAT than controls whereas therapy naïve patients had a similar VAT:TAT to controls.
Conclusions: Patients with clinical fat redistribution are distinguishable from controls by VAT:TAT measurement. Abdominal fat accumulation can occur in patients taking anti-retroviral therapy independent of protease inhibitor therapy.
Key Words: adipose tissue, CT scan, Fat redistribution
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