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
Treatment histories were significantly different between men and women (p
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.”
Further information on this website
Lipodystrophy - booklet in the information for HIV-positive people series (pdf)
Body fat changes on HAART -overview
Galli M et al. Gender differences in antiretroviral drug-related adipose tissue alterations. JAIDS 34: 58 – 61, 2003.