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Comparison of dual-energy X-ray absorptiometry and magnetic resonance imaging–measured adipose tissue depots in HIV-infected and control subjects^1,2,3,4

¹ From the University of California, San Francisco, CA (RS and PB); the Obesity Research Center, St Luke's–Roosevelt Hospital and Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, NY (WS); St Luke's–Roosevelt Hospital, Columbia University, New York, NY (DK); the Division of Preventive Medicine, University of Alabama, Birmingham, AL (CEL); the University of California and the Veterans Affairs Medical Center, San Francisco, CA (MGS and CG); St Luke's–Roosevelt Hospital, Columbia University, New York, NY (MP); and Merck & Co, Rahway, NJ (SBH)

Background:Studies in persons without HIV infection have compared adipose tissue measured by dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI), but no such study has been conducted in HIV-infected (HIV+) subjects, who have a high prevalence of regional fat loss.

Objective:We compared DXA- with MRI-measured trunk, leg, arm, and total fat in HIV+ and control subjects.

Design:A cross-sectional analysis was conducted in 877 HIV+ subjects and 260 control subjects in FRAM (Study of Fat Redistribution and Metabolic Change in HIV Infection), stratified by sex and HIV status.

Results:Univariate associations of DXA with MRI were strongest for total and trunk fat (r 0.92) and slightly weaker for leg (r 0.87) and arm (r 0.71) fat. The average estimated limb fat was substantially greater for DXA than for MRI for HIV+ and control men and women (all P < 0.0001). Less of a difference was observed in trunk fat measured by DXA and MRI, but the difference was still statistically significant (P < 0.0001). Bland-Altman plots showed increasing differences and variability. Greater average limb fat in control and HIV+ subjects (both P < 0.0001) was associated with greater differences between DXA and MRI measurements. Because the control subjects had more limb fat than did the HIV+ subjects, greater amounts of fat were measured by DXA than by MRI when control subjects were compared with HIV+ subjects. More HIV+ subjects had leg fat in the bottom decile of the control subjects by DXA than by MRI (P < 0.0001).

Conclusions:Although DXA- and MRI-measured adipose tissue depots correlate strongly in HIV+ and control subjects, differences increase as average fat increases, particularly for limb fat. DXA may estimate a higher prevalence of peripheral lipoatrophy than does MRI in HIV+ subjects.

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