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Body Habitus Assessments in HIV-Infected Women: A Cross-Sectional Study J. JUSTMAN*1, E. SMIT2, A. DANOFF1, R. LI2, M. BACON3, B. HEIKES4, J. DEHOVITZ5, K. MULLIGAN6, and M. COHEN7.
1Bronx-Lebanon Hosp. Ctr., NY; 2Johns Hopkins Sch. Publ. Hlth., Baltimore, MD; 3Georgetown Univ. Med. Ctr., Washington, DC; 4Univ. of Southern California, Los Angeles; 5SUNY Downstate Med. Ctr., Brooklyn, NY; 6 Univ. of California San Francisco; and 7Cook County Hosp., Chicago, IL and the Women's Interagency HIV Study (WIHS) Objective: To assess the association between antiretroviral therapy (ART) use and body habitus, using both objective and subjective measures, among 1471 nonpregnant women enrolled in the WIHS, a multicenter cohort study.
Methods: Height, weight, and upper arm, breast, waist and hip circumferences were measured. Physical appearance and presence of dorsocervical fat pad were also determined. A questionnaire assessed self-reported body changes. ART was classified as highly active (HAART), mono/combination (M/C) or no treatment (NTx).
Results: (1) Mean body mass index (BMI) and arm, breast, waist and hip circumference measurements are smaller among the HIV-infected than -uninfected women (p<0.001). ART category is not associated with smaller or larger BMI or circumference measurements. (2) Dorsocervical fat pads, as noted by an examiner, occurred more frequently among HIV-infected than –uninfected women (14% v. 8.8%, p=.007). ART category was associated with the presence of a fat pad (10% NTx, 14% M/C and 17% HAART, p =0.004). Obesity (BMI>30) was also associated with the presence of an examiner-reported fat pad (p<0.0001). Only 20% of examiner-reported fat pads were also self-reported. (3) HIV-infected women reported both increased and decreased abdomen sizes more often than HIV-uninfected women (p<0.001). The frequency of any self-reported change in abdomen size is associated with ART group (35% NTx v. 43% HAART, p=0.001). Any unintentional body change is also associated with HIV infection (p=0.0001) and ART group (p<0.0001).
Conclusion: Body changes, including dorsocervical fat pads, were reported among both HIV-uninfected and HIV-infected women, and among women in all ART categories. Examiner-reported fat pads were more prevalent among obese women. Subjective assessments of body habitus changes by either self-report or non-blinded clinician are associated with ART, however, these findings are not supported by objective data. Although this discrepancy highlights the need to interpret ART-associated changes in body habitus with caution, these changes may be occurring in a subset of women on ART.
Key Words: Lipodystrophy, observational cohort, women
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