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More fat loss than fat gain in HIV positive women

Changes in body shape and appearance have always been a feature of HIV/AIDS. In the early days of the epidemic, AIDS was more strongly associated with weight loss, so much so that in parts of sub-Saharan Africa, AIDS was also called “Slim” disease.

When HAART became available in high-income countries in the mid-to-late 1990s, strange changes in body shape began to be reported by some HAART users. These changes include the following:

* growth of fat on the back at the base of the neck (buffalo hump)

* increased breast size in women

* increased fat deep inside the belly (visceral fat)

In other parts of the body, the fat layer just underneath the skin (subcutaneous fat) may begin to grow thinner. This is obvious on the face, arms and legs. As the fat layer disappears, veins begin to bulge out.

But not all the changes are physical, some happen on a smaller scale inside the body. Lab tests have detected other changes in blood samples from some HAART users, including the following:

* increased levels of lipids—cholesterol and triglycerides

* increased levels of sugar (glucose) and the hormone insulin

Together, all of these physical and biochemical changes have been grouped under the term “HIV lipodystrophy syndrome.”

Most of the work trying to document and understand lipodystrophy has been in HIV positive men. Now researchers in the United States have recently released results from a large study in women. According to their results, fat loss just under the skin covering the arms, legs and buttocks, as well as the stomach, chest and back, is twice as common in HIV positive women as compared to HIV negative women. Overall, similar proportions of HIV positive and negative women experienced fat gain in the belly and breasts.

Study details

Since 1994, researchers in five American cities—Chicago, Los Angeles, New York, San Francisco and Washington D.C.—have been studying the health of women with HIV or at high risk of becoming HIV positive as part of WIHS— the Women’s Interagency HIV Study. Volunteers or research subjects visit study clinics twice a year to undergo extensive interviews, receive a physical exam and have blood drawn for lab tests.

In 1999, nurses at the study clinics began to measure and record the size of certain parts of the body (triceps, hips, chest and so on). Changes in the fat layer on the face were not assessed in this study. Technicians also performed BIA (bioelectric impedance analysis) tests to assess the proportion of body fat. Research staff monitored subjects for a period of 2½ years between 1999 and 2002. Information was collected from a total of 815 women who had the following HIV test result:

* 605 women were HIV positive

* 210 women were HIV negative

Except for the purposes of comparison, our report will focus on HIV positive women. At the time they entered the study, the average profile of the HIV positive subjects was as follows:

* age – 41 years

* weight – 68 kg (150 lbs)

* percentage of body fat – 26%

* 60% were Black

* 23% were Hispanic

* 17% were white

* CD4+ cell count – 366 cells

* viral load – 2,000 copies

In general, HIV negative women of similar age, height and race weighed more and had a greater proportion of body fat (31%) than did HIV positive women (26%).

Results—Body weight and fat

Over the course of the 2½ year study, the average weight among HIV positive women remained stable. In contrast, HIV negative women had a tendency to gain about a half kilogram every six months.

Just as the overall weight remained stable in HIV positive women, so did the proportion of their body that consisted of fat. In HIV negative women, the percentage of body fat increased by about 1% every six months.

Results—Fat loss and fat gain

* The good news: Over the course of the study, half of the HIV positive women did not develop any measurable fat gain or fat loss.

* The bad news: HIV positive women were twice as likely as HIV negative women to lose fat under the skin (subcutaneous fat) in the following places: arms, legs, buttocks and on the stomach, chest and back.

* Both groups of women experienced roughly similar levels of fat gain in the belly.

* Only about 14% of HIV positive women experienced simultaneous fat loss and fat gain.

Bear in mind

In summary, in this large American study, HIV positive women have lower average body weight and percentage of body fat than HIV negative women of a similar age. This may occur because HIV infection affects body weight and composition, particularly fat content.

HIV positive women compared to HIV negative women are more likely to lose fat under the skin in the central parts of their body (chest and back) as well as in the skin covering their arms and legs. This finding suggests that fat loss may be a major change in body composition occurring among HIV positive women.

The WIHS report had a number of limitations. Studies on body composition conducted in this century have included assessment of body fat using X-ray (CAT, DEXA) and magnetic (MRI) scans. These can also detect fat deposited deep inside the belly—visceral fat. Because none of these scans were used, researchers cannot be certain about changes in visceral fat levels.

Also, no analysis was made about the use of HAART medications and their possible relationship to fat gain or loss. Perhaps as a next step the research team could find out if treatments used by their study subjects were associated with body shape changes. This analysis would be an important step forward in trying to understand why half of the HIV positive women did not develop significant changes in body shape during the 2½ years that they were under observation.

— R. Hosein

REFERENCE

Tien PC, Cole SR, CM, et al. Incidence of lipoatrophy and lipohypertrophy in the Women’s Interagency HIV Study. Journal of Acquired Immune Deficiency Syndromes 2003;34(5):461-466.

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