Background: Lipodystrophy in HIV-infected patients (LDHIV) is characterized by peripheral lipoatrophy, central adiposity, dyslipidemias, and insulin resistance. The LDHIV-associated alterations in the blood adipocytokines, adiponectin and leptin, have not been well characterized.

Methods: A case-control study assessing fasting plasma adiponectin, leptin, and insulin levels also compared to serum lipids, anthropometry, hydrodensitometry (HDF), and DEXA scans. Cases (n = 16, male, HIV⁺) were severely lipodystrophic with both marked peripheral loss and central gain, all with current protease inhibitor (PI) therapy. Controls (n = 14, male, HIV⁺) were non-lipodystrophic without prior PI-inclusive HAART. Statistical analysis: Wilcoxon Rank Sum, 2-tailed exact test for group comparison, Spearman for correlation, and analysis of covariance.

Results: LDHIV patients (pts) compared to control subjects had lower adiponectin levels (3.2 ±3.1 vs 5.9 ±2.9 µg/mL, mean ±SD, p = 0.01; p = 0.0004 after age-covariate adjustment), similar leptin levels (3.5 ±1.5 vs 3.0 ±1.6 ng/mL, p = 0.49; p = 0.82 after BMI-covariate adjustment), and higher insulin levels (20 ±11 vs 12 ±6 µU/mL, p = 0.04). LDHIV pts and control subjects had similar BMI’s (26.6 ±2.4 vs 25.5 ±3.1 kg/m², p = 0.19) and similar total body-fat (TBF) by DEXA (20 ±6 vs 23 ±9 %, p = 0.58) and HDF (21 ±7 vs 21 ±9 %, p = 0.69). DEXA showed markedly lower fat in the legs of LDHIV patients (12 ±5 vs 22 ±9%, p = 0.0006). LDHIV pts also had higher total cholesterol (252 ±110 vs 169 ±25 mg/dL, p = 0.02), higher triglycerides (454 ±412 vs 166 ±91 mg/dL, p = 0.002), and larger waist-to-hip circumference ratios (1.03 ±0.06 vs 0.93 ±0.03, p < 0.0001). Correlation analysis showed a strong negative relationship between adiponectin and insulin levels in the LDHIV group (r = -0.73, p = 0.01), but not in control subjects (p = 0.33). Conversely, leptin and insulin levels in the control subjects were highly correlated (r = 0.86, p < 0.0001), but not in the LDHIV group (p = 0.82). In the LDHIV and control groups, leptin levels were strongly correlated with BMI (r = 0.75 and 0.67, respectively, p < 0.009) and DEXA TBF (r = 0.72 and 0.71, p < 0.008). Neither adipocytokine showed significant correlations to serum lipids in either group.

Conclusions: Blood adiponectin levels are lower in pts with LDHIV and show a strong inverse relationship to insulin concentrations, a marker of insulin resistance. Adiponectin may be a better marker than leptin for insulin resistance in pts with LDHIV.