9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 19-21 July 2007, Sydney, Australia

RELATIONSHIP OF FAT DISTRIBUTION WITH ADIPOKINES IN HIV INFECTION: THE FRAM STUDY

Antiviral Therapy 2007; 12(Suppl. 2):L16 (abstract no. O-20)

L Kosmiski¹, DP Kotler², CE Lewis³, R Scherzer⁴, S Heymesfield⁵, P Bacchetti⁶, M Shlipak^4,6 and C Grunfeld^4,6
1University of Colorado at Denver and Health Sciences Center, Denver, CO, USA; ²St. Luke’s-Roosevelt Hospital Center, New York, NY, USA; ³University of Alabama, Birmingham, AL, USA; ⁴San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; ⁵Merck Research Laboratories, Rahway, NJ, USA; 6University of California, San Francisco, CA, USA

BACKGROUND: HIV-infected patients receiving potent antiretroviral therapy often develop changes in body fat distribution, with the dominant change being a reduction in subcutaneous adipose tissue (SAT). Because adipose tissue makes important hormones involved in whole-body energy metabolism, including leptin and adiponectin, we examined their plasma concentrations and their relationship to total and regional adiposity.

METHODS: We studied 1,143 HIV-infected and 286 controls who had adipokine levels measured in the FRAM study, which includes controls from the CARDIA study and a representative sample of HIV-infected individuals. Total and regional adiposity were measured by MRI.

RESULTS: Total and regional adiposity were positively correlated with leptin levels in both the HIV-infected and control populations (P<0.0001). In controls, total and regional adiposity were negatively correlated with adiponectin concentrations. In contrast, adiponectin had little correlation with percent body fat in the HIV-infected subjects, but maintained a negative correlation with visceral adipose tissue (VAT) and upper trunk SAT. However, leg SAT was positively associated with adiponectin in HIV-infected subjects; HIV-infected subjects in the lower decile of leg SAT for controls had paradoxically lower adiponectin concentrations (Men: HIV <10% =4.1 µg/ml versus control <10% 7.5 µg/ml, P=0.009; Women: HIV <10% 7.8 µg/ml versus control <10% 11.6 µg/ml, P=0.037). Even after controlling for leg SAT, exposure to stavudine in HIV was associated with 8% lower adiponectin (per year of exposure, 95% CI -10.3 to -5.7, P<0.0001), predominantly in those with lipoatrophy.

CONCLUSION: The normal relationships between adiponectin levels and total and regional adiposity are lost or weakened in subjects with HIV infection. This may be due to changes in adipocyte function associated with the HIV lipodystrophy syndrome. In contrast, the relationship between adiposity and leptin levels appears similar to controls in the HIV-infected population and unaffected by HIV lipodystrophy.

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2007-07-24
O-20

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