Intermuscular and subcutaneous adipose tissue distributions differ in HIV+ versus HIV-men and women.

BACKGROUND: Loss of subcutaneous (SAT) with sparing of visceral (VAT) adipose tissue (AT) has been documented in HIV + men and women. Intermuscular AT (IMAT) rivals VAT in independent associations with cardiovascular risk. OBJECTIVE: To determine whether the size and distribution of IMAT differs in HIV+ vs. HIV- men and/or women. DESIGN: We used whole-body MRI to measure VAT, IMAT and four SAT compartments and compared them by HIV status using whole-body skeletal muscle (SM) or total AT (TAT) as co-variates in multi-ethnic groups of healthy HIV- (n=86) and stable HIV+ (n=76) men and women. RESULTS: The sizes of AT depots (adjusting for SM) did not differ by HIV status, except for smaller gluteal SAT (lower trunk, between L(4)-L(5) to greater trochanter) in both sexes (P<0.05). The AT distribution (adjusting for TAT) was significantly different, with larger VAT (P<0.05) and smaller gluteal and limb SAT (P<0.05) in both HIV+ sexes; IMAT increased more with TAT in HIV+ vs. HIV- men (P<0.05 for slope interaction) but there were no significant differences in women. There were significant race by HIV interactions in AT distribution with more pronounced VAT differences in non-Hispanic white men and larger trunk SAT in African Americans HIV+ vs. HIV-. CONCLUSION: The AT distribution differed markedly in HIV+ vs. HIV- with limb and lower body SAT representing a smaller proportion of TAT in HIV+ in both sexes and IMAT representing a larger proportion of TAT in HIV+ vs. HIV- men.

A female perspective on living with HIV disease.

The study discussed in this article explored women's views of the positive and negative aspects of life with HIV. Even in the face of a stigmatizing physical illness and with elevated levels of depression and anxiety, the 55 women interviewed for the study were able to identify a large number of positive events; for many, HIV served as a motivating force for positive change. Common negative experiences included physical symptoms, a limited life span, alienation, and stigma. Results suggest that whereas women demonstrate a remarkable capacity to adapt, there are a number of specific areas where social services and community interventions can be targeted.

Interactions among sex, HIV infection, and fat redistribution.

The interactions among sex, HIV infection, and body fat redistribution are uncertain. We retrospectively compared total, subcutaneous, and visceral adipose tissue (TAT, SAT, VAT) contents, as determined by whole body MRI, in 85 HIV-infected persons, including 48 HIV-positive persons with self-reported changes in body shape, and matched healthy controls. The effect of sex on regional fat contents differed among HIV-infected persons with and without self-reported changes in body shape. Women without changes had significantly less SAT and TAT than did controls, while men with changes had significantly less SAT and TAT than did controls. Higher contents of VAT were found in both men and women with self-reported changes in body shape.

Fat distribution in HIV-infected patients reporting truncal enlargement quantified by whole-body magnetic resonance imaging.

BACKGROUND: Antiretroviral therapy has improved the prospects for people infected with HIV, but some develop a syndrome of profound body habitus and metabolic alterations that include truncal enlargement. OBJECTIVE: The purpose of this study was to define the body-composition changes associated with this syndrome by using techniques with the power to estimate regional body composition. DESIGN: We compared whole-body and regional skeletal muscle and adipose tissue contents measured by magnetic resonance imaging and dual-energy X-ray absorptiometry (DXA) in 26 HIV-infected patients and 26 matched control subjects. Twelve of the HIV-infected patients had evidence of truncal enlargement. RESULTS: HIV-infected men and women who noted truncal enlargement had similar amounts of skeletal muscle and subcutaneous adipose tissue but greater visceral adipose tissue than HIV-infected patients without truncal enlargement; these values were larger in men (P < 0.001) than in women (P = 0.08). The ratio of visceral to subcutaneous adipose tissue was greater in both men (P < 0.02) and women (P = 0.05) with truncal enlargement. Two subjects with MRI-confirmed visceral adiposity syndrome (VAS) were not taking protease inhibitors. CD4+ lymphocyte counts were higher (P < 0.001) and plasma viral burdens tended to be lower (P = 0.08) in HIV-infected patients with VAS. CONCLUSIONS: There was significantly more visceral adipose tissue in the subgroup of HIV-infected patients with truncal enlargement than in those without this sign. VAS occurs in both men and women, is associated with higher CD4+ lymphocyte counts and lower plasma HIV viral burdens, and is not limited to those receiving protease inhibitor therapy.

Effects of megestrol acetate and testosterone on body composition in castrated male Sprague-Dawley rats.

The interrelationships among sex hormones, caloric intake, and intermediary metabolism in health and disease are uncertain. Studies in malnourished patients with AIDS and cancer show that megestrol acetate (MA) therapy increases appetite, body weight, and body fat, while it decreases serum testosterone (T) concentration. In this study, the separate and combined effects of MA and T were investigated in 65 young adult, male, castrated, Sprague-Dawley rats who received subcutaneous implants containing placebo, MA, T, or both MA and T for 11 wk. By hierarchical multiple regression analysis, MA therapy decreased weight gain and food intake (P < 0.01), increased body fat (P = 0.024), decreased body protein (P < 0.001), and decreased the portion of calories accrued as protein rather than fat (P ratio, P < 0.03). T alone decreased fat (P < 0.03), but had no significant effect on food intake, the relative number of consumed calories utilized for growth (food efficiency), body weight, or protein. The interaction of MA and T did not affect food intake or food efficiency, but increased body weight (P < 0.02), protein (P < 0.05) and the P ratio (P < 0.02). The portion of weight gain as fat was reduced from 47.3% with MA alone to 27.4% when MA and T were combined. Thus, megestrol acetate has significant antianabolic effects that are independent of its effects upon food intake. The addition of testosterone to megestrol acetate partially antagonized MA's inhibition of lean mass accretion in these rats.

Relative influences of sex, race, environment, and HIV infection on body composition in adults.

BACKGROUND: The factors that control body composition in disease are uncertain. OBJECTIVE: We planned to compare the relative influences of HIV infection, sex, race, and environment on body composition. METHODS: We analyzed results of body composition studies performed by bioelectrical impedance analysis in 1415 adults from 2 cohorts: white and African American men and women from the United States, and African men and women (279 HIV-infected and 1136 control). The effects of sex and HIV infection on weight, body cell mass, and fat-free mass were analyzed by using both unadjusted and age-, weight-, and height-adjusted data. RESULTS: Control men weighed more and had more body cell mass and fat-free mass than did control women, although control women had more fat. The strongest correlates with body composition were height and weight, followed by sex. HIV infection, age, environment, and race. Control men and women weighed more and had more body cell mass, fat-free mass, and fat than did HIV-infected men. However, differences in body composition between HIV-infected and control groups were strongly influenced by sex. Of the differences in weight between HIV-infected and uninfected subjects, fat-free mass accounted for 51% in men but only 18% in women, in whom the remainder was fat. Sex effects were similar in African and American groups. CONCLUSIONS: Sex has a marked effect on the changes in body composition during HIV infection, with women losing disproportionately more fat than men. Sex-related differences in body composition were narrower in the HIV-infected groups. Race and environment had smaller effects than sex and HIV infection.

The relationship of mood, endocrine, and sexual disorders in human immunodeficiency virus positive (HIV+) women: an exploratory study.

OBJECTIVE: This exploratory study assessed the prevalence of mood disorders, sexual disorders, and endocrine abnormalities, and explored the relationship between these parameters in a sample of HIV+ women. METHOD: Fifty-four HIV+ women were evaluated with the Structured Clinical Interview for DSM-III-R (SCID) and measures of psychiatric symptom severity, psychological well-being, and sexual problems. Women also provided blood to establish CD4 cell count, serum total testosterone, and dehydroepiandrosterone sulfate (DHEAS) levels. RESULTS: Although overall levels of current Axis I diagnosis were low, Hypoactive Sexual Desire Disorder (HSDD) was diagnosed in 39% of the women. Forty-eight percent of the sample had deficient testosterone levels (below 20.0 ng/dl) and 27% had deficient DHEAS levels (below 35.0 microg/dl). We found no significant relationship between diminished sexual desire and deficient levels of testosterone, DHEAS, or mood disorder diagnoses. However, HSDD was significantly related to more depressive symptoms and lower life satisfaction. Women whose perceived risk factor for HIV infection included sexual contact were more than five times more likely to be diagnosed with a new onset HSDD than women who reported intravenous drug use (IVDU) as their only risk factor (47% vs. 9%, respectively). CONCLUSIONS: We observed what seems to be high rates of HSDD and endocrine abnormalities with very low rates of mood disorders. Interestingly, endocrine abnormalities were not associated with low sexual desire. Our findings suggest that there is a significant unmet need for treatment of Hypoactive Sexual Desire Disorder among urban HIV+ women.