Background: Abnormal body fat distribution is a complication in HIV⁺ patients (pts) that may be a side effect of antiretroviral use, but may also be associated with non-drug related factors. Most studies of fat distribution in HIV⁺ pts have relied on subjective criteria and have focused predominantly on men.

Methods: We analyzed regional body composition, using dual-energy X-ray absorptiometry, in 105 HIV⁺ and 120 HIV^- women, and assessed the impact of antiretroviral use and non-drug related factors on regional adiposity. T-tests were used to compare measurements between groups, and linear regression was performed to assess factors independently associated with fat distribution.

Results: Mean age was 45 ±5 yrs; 45% were African American, 36% Hispanic and 15% white. Among HIV⁺ women, median CD4⁺ count was 464 cells/mm³; 68% reported protease inhibitor (PI) use and 61% stavudine (D4T) use. Body composition measurements (mean ±SD) are shown in the table (*p < 0.05). Body mass index (BMI) and percentage body fat were decreased and percentage lean body mass increased in the HIV⁺ women compared with HIV^- women. Among HIV⁺ women, percentage truncal fat and truncal fat/extremity fat ratio were increased and percentage extremity fat decreased in women with PI use compared with PI-naive women, and in women with D4T use compared with no D4T use. African Americans had decreased percentage truncal fat (50.2 ±7.7 vs 54.1 ±7.0, p = 0.008) and truncal fat/extremity fat ratio (1.1 ±0.4 vs 1.3 ±0.4, p = 0.01) and increased percentage extremity fat (46.3 ±7.4 vs 42.6 ±7.0, p = 0.009) compared to non-African Americans . D4T use and African Americans race remained significantly associated with African Americans truncal fat, African Americans extremity fat, and truncal fat/extremity fat ratio after controlling for age, CD4 count, and PI use on multivariate analyses.

Conclusions: HIV is associated with decreased BMI and African Americans body fat, but not with fat distribution in older women. Among HIV⁺ women, D4T use and non-African Americans race are independently associated with increased truncal fat and decreased extremity fat, while PI use is not.

	HIV-(120)	HIV+ (105)	HIV+ PI- (33)	HIV+ PI+ (72)	HIV+ D4T- (40)	HIV+ D4T+ (64)
BMI (kg/m2)	31.7 ±7.3	28.4 ±6.3*	28.5 ±7.6	28.3 ±5.6	28.6 ±8.1	28.2 ±4.9
Body fat (%)	40.1 ±8.4	35.8 ±8.7*	35.3 ±12.1	36.0 ±6.8	36.1 ±10.1	35.7 ±7.9
Lean body mass (%)	56.7 ±7.9	60.8 ±8.4*	61.2 ±11.6	60.6 ±6.5	60.4 ±9.6	61.0 ±7.6
Truncal fat (%)	50.9 ±5.6	52.0 ±7.6	49.7 ±8.0	53.1 ±7.2*	48.6 ±6.6	54.0 ±7.4*
Extremity fat (%)	46.0 ±5.5	44.6 ±7.4	46.8 ±7.6	43.6 ±7.2*	48.0 ±6.2	42.6 ±7.4*
Trunk fat/extremity fat	1.1 ±0.3	1.2 ±0.4	1.1 ±0.4	1.3 ±0.4	1.0 ±0.3	1.3 ±0.4*