Body Fat and Blood Lipid Levels in Men and Women with HIV

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By Liz Highleyman

Body shape changes and abnormal blood fat levels (dyslipidemia) are among the most troublesome side effects of antiretroviral therapy, and are associated with an elevated risk of cardiovascular disease. In particular, higher levels of triglycerides and total and low-density lipoprotein (LDL or "bad") cholesterol are associated with atherosclerosis (hardening of the arteries), while high-density lipoprotein (HDL or "good") cholesterol is considered protective.

The relationship between body fat and lipid levels in people with HIV, however, is not well understood.

In the May 1, 2008 Journal of Acquired Immune Deficiency Syndromes, investigators with the Fat Redistribution and Metabolic Changes in HIV Infection (FRAM) study presented results from 2 analyses looking at this association, one in women and one in men.

Study 1 -- Women

In the first analysis, Judith Currier and colleagues assessed the association between regional adipose (fat) tissue as measured by magnetic resonance imaging (MRI) and fasting lipid levels in 284 HIV-infected women and 129 HIV negative control women.

Results

• Among African American women, compared with HIV negative control subjects, HIV positive women had:
• Higher triglyceride levels (116 vs 83 mg/dL; P < 0.001);
• Similar HDL levels (52 vs 50 mg/dL; P = 0.60);
• Lower LDL levels (99 vs 118 mg/dL; P = 0.008).

• Among white women, those with HIV had:
• Higher triglyceride levels (141 vs 78 mg/dL; P < 0.001);
• Lower HDL levels (46 vs 57 mg/dL; P < 0.001);
• Slightly lower LDL levels (100 vs 107 mg/dL; P = 0.059).

• After adjusting for demographic and lifestyle factors, the highest third of visceral adipose tissue (VAT) was associated with higher triglyceride levels (+85%) and lower HDL levels (-9%) levels in HIV positive women.

• The highest third of leg subcutaneous adipose tissue (SAT) was associated with lower triglyceride levels in both HIV infected women (-28%) and controls subjects (-39%).

• After further adjustment for adipose tissue, HIV infection remained associated with higher triglyceride levels (+40%) and lower LDL levels (-17%).
• HIV infection was associated with lower HDL levels (-21%) in white women, but not in African American women (+8%).

"HIV-infected white women are more likely to have proatherogenic [promoting atherosclerosis] lipid profiles than HIV-infected African American women," the study authors concluded.

"Less leg SAT and more VAT are important factors associated with adverse lipid levels," they added. "HIV-infected women may be at particular risk for dyslipidemia because of the risk for HIV-associated lipoatrophy."

Department of Medicine, University of California, Los Angeles, Los Angeles, CA; Department of Veterans Affairs Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Merck, Rahway, NJ; Department of Medicine, University of California, San Diego, San Diego, CA; Kaiser Permanente, Division of Research, Oakland, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA.

Study 2 -- Men

David Wohl and colleagues, also with FRAM, conducted a similar analysis of the association between VAT and SAT measured by MRI and fasting blood lipid levels in 737 HIV-infected men and 145 HIV negative control men.

Results

• Compared with uninfected control subjects, HIV positive men had:
• Higher median triglyceride levels (170 vs 107 mg/dL; P < 0.0001);

• Lower HDL levels (38 vs 46 mg/dL; P < 0.0001);

• Lower LDL levels (105 vs 125 mg/dL; P < 0.0001).

• After adjustment, greater VAT was associated with higher triglyceride levels and lower HDL levels in HIV-infected and HIV negative control men.

• Greater leg SAT was associated with lower triglyceride levels in HIV-infected men, with a similar trend in control men.

• More upper trunk SAT was associated with higher LDL and lower HDL in control men.

• More lower trunk SAT was associated with higher triglycerides in control men.

• After adjustment, HIV infection remained strongly associated with higher triglycerides (+76%), lower LDL (-19%), and lower HDL (-18%) (P < 0.0001).

• The men's analysis did not reveal significant differences between racial groups.

"HIV-infected men are more likely than controls to have higher triglycerides and lower [HDL], which promote atherosclerosis, but also lower [LDL]," the researchers concluded.

"Less leg SAT and more VAT are important factors associated with high triglycerides and low [HDL] in HIV-infected men," they continued. "The reduced leg SAT in HIV-infected men with lipoatrophy places them at increased risk for proatherogenic dyslipidemia."

AIDS Clinical Trials Unit, University of North Carolina, Chapel Hill, NC; Northern California Institute for Research and Education, San Francisco, CA; Merck Inc., Rahway, NJ; Veterans Affairs Medical Center, New York Harbor Healthcare System, New York, NY; Division of Research, Kaiser Permanente, Oakland, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Veterans Affairs Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA.

05/16/08

References

J Currier, R Scherzer, P Bacchetti, and others (Fat Redistribution and Metabolic Changes in HIV Infection Study Investigators). Regional Adipose Tissue and Lipid and Lipoprotein Levels in HIV-Infected Women. Journal of Acquired Immune Deficiency Syndromes 48(1): 35-43. May 1, 2008.

D Wohl, R Scherzer, S Heymsfield, and others (Fat Redistribution and Metabolic Changes in HIV Infection Study Investigators). The Associations of Regional Adipose Tissue With Lipid and Lipoprotein Levels in HIV-Infected Men. Journal of Acquired Immune Deficiency Syndromes 48(1): 44-52. May 1, 2008.