3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 23-26 October 2001, Athens, Greece

ABDOMINAL FAT DISTRIBUTION ESTIMATED BY CT SCAN AND ANTHROPOMETRY. IN SEARCH OF AN OBJECTIVE DEFINITION OF LIPODYSTROPHY

Antiviral Therapy 2001; 6(Suppl. 4):29 (abstract no. 39)

F Blanco, T Garcia-Benayas, JM Gomez-Viera, T Corcuera, F Gomez, J Cabo, J de la Cruz, V Soriano and J Glez-Lahoz
Instituto de Salud Carlos III, Madrid, Spain

BACKGROUND: An accurate definition of lipodystrophy (LD) body-shape changes based on measurable parameters is still lacking. CT scan assessment of abdominal fat compartments might be useful to establish an objective criterion of abdominal LD.

OBJECTIVES: To analyse the relationship between anthropometry (APM) and abdominal lipo-hypertrophy (ALH) defined by CT scan in HIV-positive patients.

METHODS: Cross-sectional study of 117 HIV-positive patients who underwent a CT scan at umbilicus level to evaluate abdominal fat distribution. Total, visceral and subcutaneous adipose tissue (TAT, VAT and SAT, respectively) were assessed. Age, sex, risk behaviour for HIV infection, CD4 count, viral load (VL) and APM data [body mass index (BMI), suprailiac (SI) and abdominal (AB) skinfolds and waist to hip ratio (WHR)], were analysed. ALH was defined as a VAT/TAT ratio above the mean +1 so of VAT/TAT value obtained in 21 naïve patients. Bivariate and logistic regression analysis were performed.

RESULTS: Mean age was 40±8 years; males 84%; on highly active antiretroviral therapy 80%; mean CD4 count 597±330 cell/mm³; VL<50 copies/ml in 62%; ALH in 47%; mean VAT/TAT in naïve patients was 0.42±0.22. In the univariate analysis ALH was significantly associated to: age (42±9 versus 38±7 years), VL <50 copies/ml (78 versus 48%), SI skinfold (9±4versus 18±9 mm), AB skinfold (14±7 versus 24±11 mm), hip circumference (89±8 versus 92±6 cm) and WHR ratio (0.96±7 versus 0.93±6). In the multivariate analysis, only undetectable VL, smaller SI and AB skinfolds, and higher WHR, remained significantly associated to ALH values.

CONCLUSIONS: CT scan VAT/TAT values above the mean + 1 so recorded in HIV-positive naïve patients might be used as criterion for ALH diagnosis. LD characteristic changes observed in the abdomen (visceral fat accumulation and subcutaneous fat loss) are well reflected by anthropometric measurements (WHR and AB skinfolds). The association of undetectable VL with ALH might just reflect good adherence to antiretroviral treatment, which is considered the main LD pathogenic factor.

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