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Fat Loss and Fat Accumulation in HIV Patients
Are Distinct Syndromes with No Common Factor Underlying Their Prevalence
At present, no uniform
definition of HIV-associated
lipoatrophy
exists. The risk factors for fat
atrophy (FA) and
central
fat deposition (FD) are
multifactorial. Researchers at Tufts and Harvard Universities assessed
the evolution and predictors of FA and FD
in HIV-infected men and women.
Participants (n
= 452) were evaluated at baseline (starting
in November 1998) and 1 year later. FA was
defined as triceps skin-fold measurement less than
the 10th percentile on the National Health and
Nutrition Examination Survey for sex and age. FD
was defined as a waist-to-hip ratio of >0.95
for men and of >0.85 for women. Predictors
of the baseline prevalence of FA and FD and
new cases of each syndrome after 1 year were
determined.
Results
· The
baseline prevalences of FA, FD, and combined FA
and FD were 35%, 44%, and 14%, respectively.
· Twenty-two
percent of subjects had newly developed FA at
1 year, and 16% of subjects with FA at baseline
did not have it at 1 year.
· 23%
of subjects had newly developed FD at 1 year,
and 15% of those with FD at baseline did not
have it at 1 year.
· The
risk of developing new FA was increased among
participants with low triceps skin-fold values (P
< .001), smaller hips (P < .001),
higher nadir
HIV load (P =
.006), abacavir
(Ziagen use (P
< .001), stavudine
(Zerit) use
(P < .001), and use
of HAART
(P = .002).
· The
risk of developing new FD was higher among
women (P < .001) and among participants
with greater body fat levels (P = .005)
and higher triglyceride
levels (P < .001),
and it was lower among those with a high school
education (P = .003) and higher triceps
skin-fold values (P = .026).
Conclusions
Based
on these results, the authors conclude, “FA and FD are common in
HIV-infected patients, but may change over time in the individual.”
“FA
and FD appear to be different syndromes, because risk factors for
their development differ, and the prevalence of the combined syndrome
differs from the prevalences of the 2 independent syndromes.”
Department
of Public Health and
Family Medicine, Tufts University
School of Medicine, Departments
of Epidemiology and Biostatistics,
Harvard School of Public
Health, and Department of Medicine,
Tufts New England
Medical Center, Boston, Massachusetts.
06/24/05
Reference
D L Jacobson and others. Prevalence of, Evolution
of, and Risk Factors
for Fat Atrophy and
Fat Deposition in a
Cohort of HIV-Infected Men
and Women. Clinical Infectious Diseases
40(12):1837-1845. June 15, 2005.
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