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Women Interagency HIV Study Report
Incidence of Lipoatrophy and Lipohypertrophy in the Study

By Jules Levin

March 14, 2003

Fat distribution changes including central fat gain and/or peripheral fat loss, often referred to as "lipodystrophy syndrome," have been linked with HIV infection and are the focus of increasing concern. The study investigated the incidence of lipoatrophy (LA) and lipohypertrophy (LH) (fat gain) in HIV+ and HIV-women from the Women's Interagency HIV Study (WIHS), a prospective multi-site study of the progression of HIV infection in women.

Researchers included 1,057 HIV+ and HIV- women with prospective data collected semiannually on self-report of change (bi-directional) in body fat, anthropometric measurements, weight and bioelectric impedance analysis beginning in 1999 in the incidence analysis over an 18-months (mo) period (WIHS semiannual visits 11 to 14). The WIHS study consists mostly of African-American and Latino women. LA and LH were defined by self-report of either a decrease or an increase in a body fat region over the previous 6 months confirmed by change in the corresponding anthropometric measurement. Both LA and LH were studied peripherally (arms, legs, buttocks) and centrally (waist, chest, and upper back).

HIV+ and HIV- women had similar distributions of age, race, and height. Over an 18-month period, mean weight increased at a rate of 0.7 kg per visit in HIV- women and total body fat increased at a rate of 1.2 percent per visit but both remained stable in HIV+ women. Among HIV+ women, the incidence of both peripheral LA (relative hazard [RH] = 2.4) and central LA (RH = 2.1) were double that of HIV- women. So, although weight and total body fat in HIV+ women remained the same, peripheral and central fat loss occurred. Similar to the FRAM findings in men, the incidence of peripheral LH (fat gain) was lower (RH = 0.6) among HIV+ compared to HIV- women, while the incidence of central LH was similar in HIV+ and HIV- women. The majority of the combined outcomes were either combined peripheral LA and central LA or combined peripheral LH and central LH.

The study authors concluded that these prospective data suggest that LA affecting both peripheral and central sites predominate in women with HIV. The simultaneous occurrence of peripheral LA and central LH was not common in these women. These findings are similar to those from FRAM.

Abst. 736. Retrovirus Conference, Feb 10-14, Boston, MA. P. C. Tien1, S. R. Cole2, C. M. Williams3, R. Li2, J. Justman4, M. H. Cohen5, M. Young6, N. Rubin7, M. Augenbraun8, C. Grunfeld1. 1Univ of California at San Francisco; 2Johns Hopkins Univ, Baltimore, MD; 3Natl Inst of Allergy and Infectious Diseases, NIH, Bethesda, MD; 4Bronx-Lebanon Hosp Ctr, Bronx, NY; 5Cook County Hosp, Chicago, IL; 6Georgetown Univ Med Ctr, Washington, DC; 7Univ of Southern California, Los Angeles; and 8State Univ of New York-Downstate Med Ctr, Brooklyn

Jules Levin is reporting from NATAP.

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