Background: Peripheral lipoatrophy (pLA) is often described in HIV⁺ men. In the FRAM study, pLA determined by self-report and physical exam was the dominant syndrome that differed for HIV⁺ men and control men (CON). The regional body composition of HIV⁺ men with pLA (pLA⁺) and those without pLA (pLA^-) is not well understood. We determined body composition in pLA⁺ and pLA^- men and CON men in the FRAM Study.

Methods: We compared 158 pLA⁺ men and 249 pLA^- men from 18 centers between the ages of 33–45 yrs, with no opportunistic infection in the last month, to 153 CON in the same age range from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. pLA was defined as any self-report of fat loss in the cheeks, face, arms, legs, and/or buttocks confirmed by physical exam. DXA data were analyzed for 60% of the men in this study. MRI quantified lower and upper trunk subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). At this time, MRI data have been analyzed on 86% of the men.

Results: pLA⁺ men had lower BMI, less limb fat (by DXA), and less lower trunk and upper trunk SAT (by MRI) than pLA^- men. Of note pLA^- men had lower BMI, less limb fat (by DXA) and less lower trunk SAT (by MRI) than CON. There was a smaller difference between pLA^- men and CON in upper trunk SAT. VAT increased from pLA⁺ to pLA^- to CON, but only the pLA⁺ vs CON comparison reached statistical significance (p < 0.001).

 

Measure	pLA+ HIV+	pLA- HIV+	p- value*	CON	p- value**
BMI (median kg/m2)	23.6	24.7	< 0.001	27.0	< 0.001
DXA Limb Fat (median kg)	3.8	6.4	< 0.001	9.4	< 0.001
MRI lower trunk SAT (median L)	2.6	4.2	< 0.001	5.9	< 0.001
MRI upper trunk SAT (median L)	1.6	2.1	< 0.001	2.4	0.064
MRI VAT (median L)	1.3	1.7	0.072	1.9	0.054

*pLA⁺ HIV⁺ vs pLA^- HIV⁺, by Mann-Whitney test

 **pLA^- HIV⁺ vs CON, by Mann-Whitney test

 

Conclusions: pLA⁺ men had less fat in both limbs and trunk SAT than pLA^- men. Decreased subcutaneous fat was not accompanied by increased VAT. The decreased limb fat and lower trunk SAT in HIV⁺ men who do not have the clinical syndrome of pLA compared to CON suggests that clinical pLA underestimates the subcutaneous fat loss found in HIV infection. The data support direct measurement of fat in studies of fat distribution changes in HIV-infection.