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Incidence of Lipoatrophy and Lipohypertrophy in the Women's Interagency HIV Study
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Reported by Jules Levin, NATAP
Journal of Acquired Immune Deficiency Syndromes (12.15.03); Vol. 34; No. 5: P.461-466::Phyllis C. Tien, MD; Stephen R. Cole, PhD; Carolyn Masters Williams, PhD; Rui Li, MS; Jessica E. Justman,
MD; Mardge H. Cohen, MD; Mary Young, MD; Nancy Rubin, DO; Michael Augenbraun, MD; Carl Grunfeld, MD, PhD
CDC HIV/STD/TB Prevention News Update Summary:
Lipodystrophy syndrome associated with HIV infection is variously defined in studies, and the lack of a consensus definition may partly explain studies' variations in reporting prevalence of the syndrome between 2 percent and 84 percent, according to the authors. This study estimated the incidence of lipoatrophy (fat loss) and lipohypertrophy (fat gain) among HIV-infected and HIV-uninfected women from the Women's Interagency HIV Study, (WIHS), a prospective multisite study of the history of HIV infection in women with or at risk for HIV, conducted since 1994.
At semiannual WIHS visits, participants answer questions about sexual practices, HIV-related symptoms and demographic and psychosocial characteristics. Participants also detail changes in body fat in the face, neck, upper back, chest, arms, legs, buttocks and waist since their last visit. If subjects report change, they are asked if the change was a fat gain or loss. Participants are also given a physical examination and tested for CD4 cell count and HIV-1 RNA.
Beginning in April-October 1999, trained clinicians conducted anthropometric measurements on 815 women with semiannual self-reported bidirectional changes in body fat over the previous six months. The researchers included anthropometric measurements, weight, and bioelectric impedance analysis in a 30-month incidence analysis on the group of women, of whom 605 were HIV positive and 210 were HIV negative. Each group had similar distributions of age, race and height. At the baseline visit, the HIV-infected women had lower median body weight, mean body weight and percent of total body fat than the uninfected women. Mean weight for the HIV-infected women remained relatively stable over the six WIHS visits included in the study, while the mean weight for uninfected women increased, as did mean percent of total body fat.
In HIV-infected women, the incidence of peripheral (arms, legs, buttocks) and central (waist, chest, upper back) lipoatrophy was nearly double that among HIV-uninfected women after adjustment for age and race.
"There was no difference between HIV-infected and HIV-negative women in the risk of central lipohypertrophy (fat accumulation in the belly), and the risk of peripheral lipohypertrophy appeared lower for HIV-positive women than for HIV-uninfected women. To our knowledge, these findings have not previously been reported," the authors noted. "Most previous studies presumed an association between peripheral lipoatrophy and central lipohypertrophy associated with HIV infection and only investigated lipoatrophy in peripheral sites and lipohypertrophy in central sites. In addition, most studies did not include an HIV-uninfected comparison group."
"In conclusion," the researchers wrote, "our findings suggest that an HIV-associated lipoatrophy syndrome affecting both peripheral and central sites may predominate in women. The presence of peripheral lipoatrophy in combination with central lipohypertrophy was uncommon in these women; therefore, lipoatrophy and lipohypertrophy should be assessed separately. These findings suggest that future research efforts should be focused on the contributions of antiretroviral therapy and other factors to the development of lipoatrophy in HIV-infected women."
Read NATAP's in-depth report on this study:http://www.natap.org/2003/dec/120503_2.htmHere is brief NATAP summary of data from this study:"...Studies on fat redistribution in HIV-infected women are few and imprecise due to small samples...the simultaneous occurrence of peripheral lipoatrophy and central lipohypertrophy was uncommon (in WIHS)...the incidence of peripheral and central lipoatrophy was about double that among HIV-uninfected women...the 30-month cumulative incidences of peripheral lipoatrophy were 27% (162/605) among HIV-infected women and 13% (27/210) among HIV-uninfected women. The relative hazard for HIV-infected women compared with HIV-negative women was 2.1... the cumulative incidences of central lipoatrophy were 23% (139/605) among HIV-infected women and 13% (27/210) among HIV-uninfected women. The adjusted relative hazard was 1.8". As you can see from data below, the incidence of developing fat accumulation in belly was not greater in HIV-infected women (18% vs 25%). HIV-uninfected women were just as likely to develop body changes, but lipoatrophy (fat loss) in both periphery and belly predominates among HIV-infected women in WIHS. I think this data supports findings from FRAM that fat loss is predominant feature of body change rather than fat accumulation.
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