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Fat Distribution in Men With HIV Infection

From the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM)

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2005 - Volume 40 - Issue 2 - p 121-131
doi: 10.1097/01.qai.0000182230.47819.aa
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Objective: Both peripheral fat loss and central fat gain have been reported in HIV infection. Which changes are specific to HIV were determined by comparison with control subjects and the associations among different adipose tissue depots were determined.

Methods: Cross-sectional analysis of HIV-positive and control men from the study of Fat Redistribution and Metabolic Change in HIV Infection. Lipoatrophy or lipohypertrophy was defined as concordance between participant report of change and examination. Regional adipose tissue volume was measured by magnetic resonance imaging (MRI).

Results: HIV-positive men reported more fat loss than controls in all peripheral and most central depots. Peripheral lipoatrophy was more frequent in HIV-positive men than in controls (38.3% vs. 4.6%, P < 0.001), whereas central lipohypertrophy was less frequent (40.2% vs. 55.9%, P = 0.001). Among HIV-positive men, the presence of central lipohypertrophy was not positively associated with peripheral lipoatrophy (odds ratio = 0.71, CI: 0.47 to 1.06, P = 0.10). On MRI, HIV-positive men with clinical peripheral lipoatrophy had less subcutaneous adipose tissue (SAT) in peripheral and central sites and less visceral adipose tissue (VAT) than HIV-positive men without peripheral lipoatrophy. HIV-positive men both with and without lipoatrophy had less SAT than controls, with legs and lower trunk more affected than upper trunk. Use of the antiretroviral drugs stavudine or indinavir was associated with less leg SAT but did not appear to be associated with more VAT; nevirapine use was associated with less VAT.

Conclusion: Both peripheral and central subcutaneous lipoatrophy was found in HIV infection. Lipoatrophy in HIV-positive men is not associated with reciprocally increased VAT.

Received for publication May 17, 2005; accepted August 4, 2005.

Supported by National Institutes of Health grants RO1-DK57508, HL74814, HL 53359, and AI 027767 and NIH GCRC grants M01-RR00036, RR00051, RR00052, RR00054, RR0636, and RR00865. The funding agency reviewed the study design but played no role in collection, management, analysis, or interpretation of the data or in preparation of the manuscript. NIH personnel participated as members of the CARDIA Publications Committee that reviewed and approved the manuscript.

Reprints: Carl Grunfeld, University of California, San Francisco Veterans Affairs Medical Center, Metabolism Section, 111F, 4150 Clement Street, San Francisco, CA 94121 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.