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Effect of highly active antiretroviral therapy on fat, lean, and bone mass in HIV-seropositive men and women^1,2,3

¹ From the Department of Family Medicine and Community Health, Boston; the Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston; and the Department of Medicine, New England Medical Center, Boston.

Background: Alterations in body composition have been reported in HIV-positive adults receiving highly active antiretroviral therapy (HAART), but the magnitude and potential determinants of these changes are unclear.

Objective: We compared total and regional body composition, as measured by dual-energy X-ray absorptiometry, in 203 HIV-positive men and 62 HIV-positive women according to HAART.

Design: This was a cross-sectional analysis of a cohort study of nutrition and HIV infection.

Results: After adjustment for age, weight, race, and exercise habits, total weight and fat mass did not differ significantly in men or women by HAART. Trunk fat was greater in men (1.0 kg; P < 0.001) and women (1.4 kg; P = 0.005) and leg fat was lower in men (-1.0 kg; P < 0.001) and women (-1.5 kg, P = 0.005) receiving HAART than in those not. This corresponded to a greater percentage of total fat mass located in the trunk (men: 7.5%, P < 0.001; women: 5.1%, P = 0.02). Lean mass was also greater with longer duration of HAART in men (P < 0.002). In men receiving HAART, total and regional bone mineral content were less than in the men not receiving HAART (P < 0.001). These effects increased with longer duration of HAART. Protease inhibitors were associated with the largest differences in regional fat.

Conclusions: HAART is associated with redistribution of fat mass from the legs to the trunk, despite no significant differences in total fat mass or weight. In men, HAART is also associated with a reduction in bone mineral content, suggesting that HAART increases the risk of central obesity and osteoporosis.

Key Words: HIV • human immunodeficiency virus • highly active antiretroviral therapy • HAART • dual-energy X-ray absorptiometry • protease inhibitors • nucleoside reverse transcriptase inhibitors • lipodystrophy • fat redistribution • lean body mass • fat mass • bone mineral content • osteopenia • osteoporosis

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