Body composition in HIV infected South Indian men
Nihal Thomas, HS Asha, Thomas Paul & Mandalam Seshadri
Background and objective: Widespread use of highly active anti-retroviral therapy (HAART) has led to a decrease in morbidity and mortality with this infection. HAART is also associated with body fat redistribution, insulin resistance and dyslipidemia, well known risk factors for cardiovascular disease. The prevalence of fat redistribution in studies ranges from 11 to 83%. The objective of this study was to look at changes in body composition in HIV infected men and to determine its association with HAART.
Study design and methods: Male patients aged between 25 and 50 years with HIV infection were recruited from the infectious diseases clinic. Drug naïve HIV patients (clinical stage-1) as well as those on successful HAART for at least 1 year in clinical stage-1 were included. Cases were compared with age and BMI matched healthy controls. Anthropometric measurements including skin fold thickness was measured. The presence or absence of facial lipoatrophy was recorded. Body composition was assessed by bio-impedance and DXA (Dual energy X-ray Absorptiometry).
Results: Fifty-seven percent of HIV cases and 31% of HIV controls had facial lipoatrophy. Eighteen out of 20 cases with facial lipoatrophy were on stavudine. Patients on stavudine were at a 2.6 times greater risk of developing lipoatrophy.
HIV cases on HAART had a lower fat mass in their limbs measured by DXA in comparison to HIV controls not on HAART and healthy controls (P=0.008 and 0.006 respectively). Limb fat mass measured by DXA correlates with triceps skin fold thickness.
Conclusion: HIV infected individuals on HAART are at risk of developing lipoatrophy with the standard National AIDS Control Organization (NACO) regimen of HAART. Stavudine use is associated with greater risk of lipoatrophy. This is the first Indian study where an objective measurement was used to document lipoatrophy.