Quantifying Abnormalities Associated with Fat Redistribution Syndrome
Many reports attempted to quantify the types of abnormalities associated with fat redistribution syndrome. Dr. Norma Muurahainen of Serono Laboratories reported on a preliminary analysis of a detailed self-assessment questionnaire performed by 208 patients. Concern about fat redistribution syndrome was very common, as were complaints of both fat accumulation (85%) and fat depletion (73%). Abdominal fat accumulation was reported in 93% of the women and 76% of the men; breast enlargement in 79% of the women and 31% of the men. 69% of men and 53% of women reported peripheral fat depletion. Other manifestations such as buffalo hump were reported less frequently. Lipid or glucose abnormalities were more common in men than women.
Dr. Julian Falutz of Montreal reported on gender-related differences in fat redistribution syndrome based on an analysis of 25 men and 13 women. Approximately half of all had both fat accumulation and fat depletion. However none of the women had fat depletion only, and over half the men had fat accumulation only. Normal serum lipids were seen in over half the women but none of the men; hypertriglyceridemia was the most common lipid abnormality.
Dr. Kathleen Mulligan from San Francisco reviewed body composition studies in women with a focus on fat redistribution syndrome. In AIDS-associated wasting in men there is a disproportionate loss of lean tissue. More recent studies show that most of the weight loss in men and women is body fat (2/3 of the weight loss in men, 80% in women). With fat redistribution syndrome both men and women develop fat accumulation and/or depletion associated with PI-containing or non-containing antiretroviral therapy. In women breast enlargement and truncal obesity (due to visceral intraabdominal fat deposition) are the most common abnormalities associated with fat redistribution syndrome in addition to wasting (fat depletion) in the buttocks, calves and thighs. An association with nucleosides 3TC and d4T as well as with protease inhibitors has been reported previously. Body composition analysis by bioimpedance testing (BIA) may not depict the degree of fat redistribution. DEXA (dual x-ray absorptiometry) is a more accurate technique but not as widely available. Anthropometry, the oldest and technically most simple method of body composition analysis continues to have value. Waist-hip ratio, midthigh circumference and caliper measurements of skin fold thickness can supplement BIA in evaluating the presence of fat redistribution syndrome. Obesity in fat redistribution syndrome in women is associated with increased energy intake (dietary counseling advised) coupled with decreased energy expenditure related to inactivity (exercise advised). Testosterone deficiency is very common in men with HIV infection but little studied in women. Recent studies indicate that this may occur in 2/3 of women with HIV-associated wasting. The role of testosterone replacement in women remains unclear and needs further study.