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More Evidence Against Link Between Fat Loss and Gain With HIV
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Lipodystrophy Workshop
Exclusive report for NATAP
November 16, 2005
Analysis of data from two Australian studies by Andrew Carr (St. Vincent’s Hospital, Sydney) confirmed the growing impression that the same mechanism cannot explain limb fat loss and central fat buildups in people with HIV infection.
Although many at first assumed that lipoatrophy (fat loss) and lipohypertrophy (fat gain) were part of the same syndrome, the just-published FRAM study and other work failed to confirm such a link (FRAM. JAIDS. 2005;40:121-131). In fact FRAM found that US men with HIV were more likely to have fat atrophy—but less likely to have central fat gains—than men in the general population.
To investigate how these HIV-related fat abnormalities may or may not be related, Carr analyzed fat trends and risk factors in people enrolled in two studies—MITOX (a switch from stavudine [d4T] or zidovudine [AZT] to abacavir) and ROSEY (rosiglitazone versus placebo in people with lipoatrophy, many of whom quit d4T or AZT). In both studies some people gained arm and leg fat over 72 weeks of follow-up.
If a single mechanism lies behind lipoatrophy and lipohypertrophy, Carr explained at the Lipodystrophy Workshop in Dublin, the analysis should show (1) that as limb fat increases, visceral fat decreases, and (2) similar risk factors for lipoatrophy and decreasing visceral fat.
But neither of those things happened. Instead, as people in these studies gained limb fat, they also gained—rather than lost—visceral fat (at week 72 r = 0.25, P = 0.001). Separate factors predicted limb fat and visceral adipose tissue change at week 72.
Predictors of increased limb fat mass at week 72:
- Higher baseline body mass index: beta 0.06 per kg/m2, P = 0.015
- Higher baseline trunk fat: beta 0.19 per ??, P < 0.0001
- Higher visceral adipose tissue at week 72: beta 0.01 per ??, P = 0.007
Predictors of lower visceral adipose tissue at week 72:
- Higher baseline high-density lipoprotein cholesterol: beta 17.9 per mmol/L, P = 0.029
- Lower baseline visceral adipose tissue: beta -0.13 per ??, P = 0.002
- Lower baseline limb fat: beta -4.31 per ??, P = 0.014
- Higher limb fat change at week 72: beta 11.7 per ??, P < 0.0001
Carr noted that limb fat improved in only 50% of these study participants after 18 months of follow-up.
H. Wand, M.G. Law, S. Emery, D.A. Cooper, A. Carr. Increase in limb fat after nucleoside analogue cessation is not associated with decreased visceral fat and has different risk factors. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005. Dublin. Abstract 3.
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