In a French study, researchers evaluated the visceral fat mass and metabolic profile of 175 HIV patients on HAART. Prior studies have demonstrated that visceral fat mass is associated with risk of insulin resistance and cardiovascular disease.

Clinical lipodystrophy was classified as atrophy in case of subcutaneous fat loss without central fat accumulation; hypertrophy for central fat accumulation and/or or lipomatosis without atrophy and mixed type for patients presenting both

characteristics.

CT measured visceral abdominal (VAT) and subcutaneous adipose tissues (SAT) at the level of the L4–L5 intervertebral disc space and the subcutaneous fat at mid-thigh. Glucose metabolism was evaluated with oral glucose tolerance test (OGTT).

Results

• Patients were 38.9% females, mean aged 40 years with a median BMI of 22.3 (16.6% BMI >26).
• Median CD4 cell count was 430/mm3, HIV–infection duration: 9.1 years, ART exposure: 5.1 years, current ART exposure: 1 year [30.9% receiving NNRTI and 68.6% PI] and 58.9% were HIV-RNA <400 copies/ml.
• Clinical lipodystrophy was 18.9% atrophy, 18.3% hypertrophy and 55.4% mixed syndrome.
• Median waist-to-hip ratio was 0.94.
• Mean VAT was 127.7 +/- 72.2 and SAT 99.2 +/- 73.9.
• There was a significant correlation between VAT measurements and waist-to-hip ratio, BMI, sex and age but not with ART exposure duration.
• OGTT results showed that 26.3% of patients present insulin resistance (IR), 10.9% diabetes, 12.6% trouble in glucose tolerance (TGT), 13.7% both IR and TGT, 36.6% were normal.
• VAT significantly increased from normal OGTT (mean 97.4 58.9) to IR (mean:127.2 +/- 69.5) or TGT (mean 134.5 +/- 79) then to IR with TGT (mean 173.5 +/- 67.2) and diabetes (mean 164.8 +/- 74.3).

In conclusion, the study authors note that these treatment-experienced patients  had high VAT that was “significantly associated to the insulin resistance profile.” In addition, they note that VAT was correlated with the waist-to-hip ratio.

The authors conclude, “These elements highlight the cardiovascular risk for HAART-treated patients with lipodystrophy, arguing for a rapid specific cardio-vascular management of such patients.

12/09/05

Reference
I Poizot-Martin and others. Visceral fat-mass in 175 HAART-treated HIV-infected patients. Abstract 31. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005, Dublin, Ireland. Antiviral Therapy 2005; 10:L22.