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HAART-treated women are at a higher risk than men receiving anti-HIV

medication of developing body fat changes, according to an Italian

study published in the September 1st edition of the Journal of

Acquired Immune Deficiency Syndromes. This was despite the men in

the study receiving anti-HIV drugs for longer and having a higher

incidence of severe HIV disease, two risk factors for lipodystrophy

observed in other studies.

Investigators from the Lipodystrophy Italian Multicentre Study

conducted a cross-sectional study involving patients seen at large

treatment centres in four major cities in a 3o day period. A total

of 2258 individuals were included in the study, 673 of whom (29.8%)

were women.

Clinical and demographic data were gathered for each patient,

including details of all anti-HIV drugs taken, and the time of, and

reasons for, discontinuing any medication.

Individuals were asked to report any changes in body shape since

starting antiretroviral therapy (or during the previous two years if

a patient was treatment naïve). A patient's doctor was asked to

confirm these reports.

Changes in body shape considered were fat accumulation between the

shoulders, fat gain at the side and front of the neck, fat

accumulation in the trunk, breasts and abdomen, and fat loss from

the buttocks, face, arms and lower limbs. Data were also gathered on

lipomas, small subcutaneous round fat masses.

The Marrakesh classification system was used to describe the type of

fat changes which individuals experienced, Type 1 being fat loss,

Type 2 fat gain, and Type 3, a mixture of fat loss and fat gain.

Investigators calculated the odds ratio for developing each type of

body fat change using a logistic regression. Risk ratios were

adjusted for age, severity of HIV disease, viral load, CD4 cell

count, overall duration of antiretroviral use, types of drug

combination used, and the use of d4T.

Men were more likely than women to have progressed to a severe stage

of HIV disease (p<0.01), men were also significantly older than

women (37 years vs 35 years), and more likely to be current or past

injecting drug users (47% vs 36%).

Treatment histories were significantly different between men and

women (p<0.001), in particular woman were more likely to have

developed body fat changes whilst treatment naïve (10% Vs 7% of

men). There were no significant differences in the percentages of

men and women who had received treatment with d4T, the drug most

commonly associated with lipoatrophy in cross-sectional

retrospective studies.

The total duration of antiretroviral treatment was comparable

between men and women, with men receiving a median of 2.9 years

therapy compared to median of 2.8 years for women.

Body fat changes were confirmed in 750 patients, 282 of who were

women (33%). Changes in body shape in any region were more frequent

in women than men, who had a significantly lower adjusted risk of

them in all cases.

The investigators observe, " the results of this large cross-

sectional study clearly show that women arte at a higher risk of

developing adipose tissue abnormalities than men. This increased

risk emerged despite their significantly less [anti-HIV] treatment,

lower stage of HIV disease…furthermore there was no significant

between-gender difference in the percentage of patients receiving

d4T (a drug reportedly associated with an increased risk of

lipoatrophy) nor in the overall duration of [antiretroviral therapy]

adjusted for the combination used. "

Marked differences in the fat loss profiles of men and women were

commented on by the investigators, with pure fat loss more

frequently reported in men than women (12% vs 9.3%, OR 0.89, 95% CI:

0.64 – 1.25, p=0.5151).

The body fat changes in women observed by the investigators did not

conform to the " android body habitus " characterised by increased

truncal fat seen in earlier studies of women with lipodystrophy.

Indeed, the investigators emphasise that their data reveal a complex

pattern of alterations, with a striking degree of fat gain in the

breasts, with or without the fat loss reported in previous studies.

" In conclusion…lipodystrophy is more frequent and more polymorphic

in women than men…studies of the role of hormonal mechanisms will

probably provide information concerning gender-related differences

in the development of lipodystrophy. "