Regional body fat distribution in HIV-infected patients with lipodystrophy

Background: Objective criteria for the assessment of patients with lipodystrophy syndrome in human immunodeficiency virus infection (LDHIV) have not emerged. Methods: We compared regional body fat changes in 13 men with severe LDHIV on protease inhibitor-inclusive antiretroviral therapy with 13 control HIV-infected men using anthropometry, dual-energy X-ray absorptiometry (DEXA), and whole-body magnetic resonance imaging (MRI). Results: LDHIV patients, compared with control subjects, had thinner gluteal, suprailiac, and triceps skinfolds (p < .01) and increased waist circumference (98 ± 5 cm vs 86 ± 9 cm, respectively; p = .0008). DEXA studies revealed reduced lower extremity fat (12 ± 5% vs 22 ± 9%; p = .0006), increased head and neck fat (18 ± 3% vs 16 ± 1%; p = .01), and increased proportion of total body fat in the trunk (65 ± 7% vs 53 ± 8%; p = .0005). MRI analysis revealed reduced thigh fat (12 ± 5% vs 22 ± 12%; p = .01), increased dorsocervical fat depth (47 ± 24 mm vs 19 ± 7 mm; p = .0009), and nearly significant increase in intra-abdominal fat (218 ± 90 cm² vs 157 ± 70 cm²; p = .057). Interestingly, control subjects showed a positive relationship between intra-abdominal and dorsocervical fat (r = .57, p = .04), but the LDHIV patients showed a negative relationship (r = -.55, p = .05), suggesting a novel split phenotype among LDHIV patients of either dorsocervical or intra-abdominal fat accumulation. Conclusions: We conclude that MRI provides the best tools for definition of LDHIV syndrome and reveals variable phenotypes among LDHIV patients.