732 Lipoatrophy is the Dominant Feature of the Lipodystrophy Syndrome in HIV-infected Men B. Gripshover*1, P. C. Tien2, M. Saag3, D. Osmond2, P. Bacchetti2, C. Grunfeld for the Investigators of the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) Study2 1Univ Hosp of Cleveland, Case Western Reserve Univ, OH; 2Univ of California at San Francisco; and 3Univ of Alabama at Birmingham
Background: A variety of changes in fat distribution have been described in HIV infection, but their association with each other and their relation to findings in HIV-uninfected persons is not well established. We investigate the prevalence of lipoatrophy (LA) and lipohypertrophy (LH) in HIV+ men and controls in the FRAM Study.
Methods: We compared 412 HIV+ men between the ages of 33-45 yrs and free of opportunistic infection in the past month from 18 centers to 153 similar age-control (CON) men from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Self-report of a mild, moderate, or severe change in peripheral sites (cheeks, face, arms, legs, and buttocks) and central sites (waist, abdominal fat, neck, chest, and upper back) were assessed. Physical exam of these sites was performed. Correlations between each of the body regions in HIV+ men were analyzed. LA was defined as any self-report of fat loss confirmed by reduced fat on exam and LH defined as self report of fat gain confirmed by increased fat on exam. Both LA and LH were studied in peripheral and central sites.
Results: In self-report, more HIV+ men than CON reported fat loss at 1 or more peripheral sites (56% vs 13.3%, p < 0.0001) and fat loss at 1 or more central sites (32.8% vs 15.1%, p < 0.0001). On exam, more HIV+ men had reduced fat in peripheral sites compared to CON men (69% vs 39.2%, p < 0.0001). Furthermore, fewer HIV+ men had increased fat in central sites on exam than CON men (61.2% vs 81.6%, p < 0.0001). Neither self-report nor exam supported a correlation between less peripheral fat and more central fat in HIV+ men. For concordance of self-report and exam, HIV+ men more frequently had peripheral LA (38.9% vs 4.6%, p < 0.0001) as well as central LA (7.8% vs 2.6%, p < 0.0312) than CON. Central LH was less frequently found in HIV+ men than CON men (40.3% vs 56.2%, p < 0.0001). In HIV+ men, peripheral LA was associated with central LA (OR 18.3, CI 5.5-61.2, p < 0.0001), but not with central LH (OR 0.70, CI 0.45-1.07, p = 0.1002).
Conclusions: These data support an HIV-associated syndrome of lipoatrophy that may include both peripheral and central sites. The data do not support a single syndrome in which peripheral LA is linked to central LH.
