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Visceral fat-mass (belly fat accumulation) in 175 HAART-treated HIV-infected patients
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I Poizot-Martin1, C Marimoutou1, D Di Stephano2, M-P Drogoul-Vey1, K Djemli1,3, P Vague3 and J-A Gastaut1 1CISIH-Sud Unite de Jour Hematologie-VIH, Departement de Recherche Clinique, Hopital Sainte-Marguerite, University
Hospital of Marseilles, Marseilles, France; 2Service d'Imagerie Medicale, Institut Paoli-Calmettes, Marseilles, France; 3Departement de Nutrition-Endocrinologie-Maladies Metaboliques, Hopital La Timone University Hospital of Marseilles, Marseilles, France
ABSTRACT 31
Antiviral Therapy 2005; 10:L22
Background: It has been established that visceral fat accumulation is highly associated with the risk of insulin resistance and cardiovascular disease.
Objectives: To evaluate the visceral fat mass and metabolic profile (glucid/lipid) in 175 HAART-treated HIV-infected patients with clinical lipodystrophy.
Methods: Cross-sectional study. Clinical lipodystrophy was classified as atrophy in case of subcutaneous fat loss without central fat accumulation; hypertrophy for
central fat accumulation and/or or lipomatosis without atrophy and mixed type for patients presenting both characteristics. CT measured visceral abdominal (VAT)
and subcutaneous adipose tissues (SAT) at the level of the L4-L5 intervertebral disc space and the subcutaneous fat at mid-thigh. Glucose metabolism was evaluated with oral glucose tolerance test (OGTT).
Results: Patients were 38.9% females, mean aged 40 years with a median BMI of 22.3 (16.6% BMI >26). Their median CD4 cell count was 430/mm3, HIV-infection duration: 9.1 years, ART exposure: 5.1 years, current ART exposure: 1 year [30.9% receiving NNRTI and 68.6% PI] and 58.9% were HIV-RNA <400 copies/ml.
Clinical lipodystrophy was 18.9% atrophy, 18.3% hypertrophy and 55.4% mixed syndrome. The median waist-to hip ratio was 0.94 [IQ: 0.90-0.99]. Mean VAT was 127.7 ±72.2 and SAT 99.2 ±73.9. There was a significant correlation between VAT measurements and waist-to-hip ratio, BMI, sex and age but not with ART exposure duration. OGTT results showed that 26.3% of patients present insulin resistance (IR), 10.9% diabetes, 12.6% trouble in glucose tolerance (TGT), 13.7% both IR and TGT, 36.6% were normal.
VAT significantly increased from normal OGTT (mean 97.4 ±58.9) to IR (mean:
127.2 ±69.5) or TGT (mean 134.5 ±79) then to IR with TGT (mean 173.5 ±67.2) and diabetes (mean 164.8 ±74.3).
Conclusions: These HAART-treated patients presented a CT-measured high VAT significantly associated to the insulin resistance profile. VAT was correlated with the waist-to-hip ratio. These elements highlight the cardiovascular risk for HAART-treated patients with lipodystrophy, arguing for a rapid specific cardio-vascular management of such patients.
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