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Ultrasonographic assessment of lipodystrophy in HIV-1-infected patients

Valutazione ecografica della lipodistrofia nei pazienti con infezione da HIV

  • Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

We performed a cross-sectional study of physical changes in HIV-infected adults to evaluate the role of ultrasonography for the diagnosis of lipodystrophy.

Materials and methods

Sixty HIV-infected patients were recruited from 1 June to 31 December 2006. A total of 34 patients were included in the lipodystrophy group and 26 in no lipodystrophy group. Thickness of subcutaneous fat was measured twice with a high-frequency (15 MHz) transducer by transverse scans at four skin-based reference points: the periumbilical region, the brachial region, the crural region and the malar region. Visceral fat thickness was determined with a low-frequency (3.75 MHz) transducer at two skin reference points: perirenal fat diameter and visceral abdominal fat.

Results

Compared with HIV-infected patients without lipodystrophy, those with lipoatrophy or mixed lipodystrophy had thinner facial, arm and leg fat, whereas patients with lipodystrophy showed thicker intra-abdominal fat. The median of the ratio between intra-abdominal fat and subcutaneous fat and between perirenal fat diameter and body mass index in the lipodystrophy group was higher than in the no lipodystrophy group. The measurements of brachial, malar and crural fat were significantly lower in patients with lipodystrophy.

Conclusions

We consider the ratio between visceral adipose tissue and subcutaneous adipose tissue and the thickness of malar fat to be the most useful ultrasonographic parameters for the early diagnosis of lipodystrophy in HIV-infected patients on highly active antiretroviral therapy.

Riassunto

Obiettivo

Abbiamo disegnato uno studio cross-sezionale sulle alterazioni morfologiche osservate nei soggetti adulti con infezione da HIV al fine di valutare il ruolo dell’ecografia nella diagnosi di lipodistrofia.

Materiali e metodi

Dal 1 giugno al 31 dicembre 2006 sono stati selezionati 60 pazienti con infezione da HIV. Trentaquattro pazienti sono stati inclusi nel gruppo con lipodistrofia e 26 nel gruppo senza lipodistrofia. È stato misurato lo spessore del tessuto adiposo sottocutaneo mediante scansione trasversale ad alta frequenza (15 MHz) in corrispondenza di quattro punti di repere: la regione periombelicale, brachiale, crurale e malare. Lo spessore del tessuto adiposo viscerale è stato valutato mediante scansioni a bassa frequenza (3,75 MHz) in corrispondenza di due punti di repere: il diametro peri-renale ed il grasso addominale.

Risultati

In relazione ai pazienti con infezione da HIV non lipodistrofici, i pazienti che hanno sviluppato lipodistrofia mista o lipoatrofia hanno un minor spessore di tessuto adiposo a carico del volto e degli arti, mentre soggetti lipodistrofici hanno un maggior accumulo di grasso viscerale. La mediana del rapporto tra spessore di tessuto adiposo viscerale e addominale superficiale e del rapporto tra grasso peri-renale ed indice di massa corporea è significativamente più alta nei pazienti lipodistrofici.

Conclusioni

Consideriamo il rapporto tra tessuto adiposo viscerale (VAT) e tessuto adiposo sottocutaneo (SAT) e lo spessore del grasso malare come i parametri ecografici più utili per effettuare una diagnosi precoce di lipodistrofia in pazienti con infezione da HIV in terapia antiretrovirale.

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References/Bibliografia

  1. Palella FJ, Delaney KM, Moorman AC et al (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient Study Investigators. N Engl J Med 338:853–860

    Article  PubMed  Google Scholar 

  2. Behrens G, Dejam A, Schmidt H et al (1999) Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. AIDS 13:F63–F70

    Article  PubMed  CAS  Google Scholar 

  3. Carr A, Cooper DA. (2000) Adverse effects of antiretroviral therapy. Lancet 356:1423–1430

    Article  PubMed  CAS  Google Scholar 

  4. Carr A, Samaras K, Burton S et al (1988) A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 12:F51–F58

    Article  Google Scholar 

  5. Lichtenstein KA, Ward DJ, Moorman AC et al (2001) Clinical assessment of HIV associated lipodystrophy in an ambulatory population. AIDS 15:1389–1398

    Article  PubMed  CAS  Google Scholar 

  6. Schwenk A (2002) Methods of assessing body shape and composition in HIV associated lipodystrophy. Curr Opin Infect Dis 15:9–16

    PubMed  Google Scholar 

  7. Carr A, Samaras K, Thorisdottir A et al (1999) Diagnosis, prediction, and natural course of HIV-1 proteaseinhibitor-associated lipodistrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 353:2093–2099

    Article  PubMed  CAS  Google Scholar 

  8. Martinez E, Bianchi L, Garcia-Viejo MA et al (2000) Sonographic assessment of regional fat in HIV-infected people. Lancet 356:1412–1413

    Article  PubMed  CAS  Google Scholar 

  9. Saint-Marc T, Partisani M, Poizot-Martin I et al (2000) Fat distribution evaluated by computed tomography and metabolic abnormalities in patients undergoing antiretroviral therapy: preliminary results of the LIPOCO study. AIDS 14:37–49

    Article  PubMed  CAS  Google Scholar 

  10. Mallon PWG, Miller J, Cooper DA, Carr A (2003) Prospective evaluation of the effect of antiretroviral therapy on body composition in HIV-1 infected men starting therapy. AIDS 17:971–979

    Article  PubMed  CAS  Google Scholar 

  11. Gulizia R, Vercelli A, Gervasoni C et al (2006) Controversy concerning role of ultrasonographic lipoatrophy assessments in HIV patients. AIDS 20:789–790

    Article  PubMed  Google Scholar 

  12. Moyle GJ, Lysakova L, Brown S et al (2004) A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection. HIV Med 5:82–87

    Article  PubMed  CAS  Google Scholar 

  13. Asensi V, Martin-Roces ER, Carton JA et al (2004) Perirenal fat diameter measured by echography could be an early predictor of lipodystrophy in HIV-type 1 infected patients receiving highly active antiretroviral therapy. Clin Infect Dis 39:240–247

    Article  PubMed  Google Scholar 

  14. Asensi V, Martin-Roces ER, Collazos J et al (2006) Association between physical and Echographic fat thickness assessments and a lipodystrophy grading scale in lipodystrophic HIV patients: pratical implications. AIDS Res Hum Retroviruses 22:830–836

    Article  PubMed  Google Scholar 

  15. Blanch J, Rousaud A, Martinez E et al (2002) Impact of lipodystrophy on the quality of life of HIV-1 infected patients. J Acquir Immune Defic Syndr 31:404–407

    PubMed  CAS  Google Scholar 

  16. Satler F (2003) Body habitus changes related to lipodystrophy. Clin Infect Dis 36[Suppl 2]:S84–S90

    Article  Google Scholar 

  17. Coress IB, Nicholas PK, McGibbon CA et al (2004) Weight change, body image, and quality of life in HIV disease: a pilot study. Appl Nurs Res 17:292–296

    Article  Google Scholar 

  18. Burgoyne R, Collins E, Wagner C et al.(2005) The relation between lipodystrophy associated body changes and measures of quality of life and mental health for HIV-positive adults. Qual Life Res 14:981–990

    Article  PubMed  Google Scholar 

  19. Carey D, Wand H, Martin A et al (2005) Evaluation of ultrasound for assessing facial lipoatrophy in a randomized, placebo-controlled trial. AIDS 19:1325–1327

    Article  PubMed  Google Scholar 

  20. Zylberger H, Nalpas B, Pol S et al (2000) Is there a relationship between hepatitis C virus infection and antiretroviral-associated lipoatrophy? AIDS 14:2055–2065

    Article  Google Scholar 

  21. Torti C, Patroni A, Tinelli C et al (2002) Influence of hepatitis C virus coinfection on lipid abnormalities in HIV-positive patients after highly active antiretroviral therapy. J Acquir Immune Defic Syndr 29:315–317

    PubMed  Google Scholar 

  22. Rodriguez-Guardado A, Maradona JA, Asensi V et al (2003) Hepatitis C in patients with HIV infection and lipodystrophy. J Acquir Immune Defic Syndr 32:348–349

    Article  PubMed  Google Scholar 

  23. Sulkowski MS, Mehta SH, Torbenson M et al (2005) Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus. AIDS 6:585–592

    Article  Google Scholar 

  24. Pol S, Lebray P, Vallet-Pichard A (2004) HIV infection and hepatic enzyme abnormalities: intrincacies of the pathogenic mechanisms. Clin Infect Dis 38[Suppl 2]:S65–S72

    Article  PubMed  CAS  Google Scholar 

  25. Miller KD, Cameron M, Wood LV et al (2000) Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases. Ann Intern Med 133:192–196

    PubMed  CAS  Google Scholar 

  26. Fortgang IS, Belitsos PC, Chaisson RE et al (1995) Hepatomegaly and steatosis in HIV-infected patients receiving nucleoside analog antiretroviral therapy. Am J Gastroenterol 90:1433–1436

    PubMed  CAS  Google Scholar 

  27. Lonardo A, Adinolfi LE, Loria P et al (2004) Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease. Gastroenterology 126:586–597

    Article  PubMed  CAS  Google Scholar 

  28. Mehta SH, Moore RD, Thomas DL et al (2003) The effect of HAART and HCV infection on the development of hyperglycemia among HIV-infected persons. J Acquir Immune Defic Syndr 33:577–584

    Article  PubMed  CAS  Google Scholar 

  29. Gulizia R, Brunetti E, Gervasoni C et al (2005) Sonographic assessment of lipodystrophy in HIV-infected patients: some open questions. Clin Infect Dis 40:323–324

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Operative Unit of Infectious Diseases, S. Caterina Novella’s Hospital, Via Roma 1, 73013, Galatina, Lecce, Italy

    P. F. Grima, R. Chiavaroli & P. Grima

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  1. P. F. Grima
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  2. R. Chiavaroli
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Correspondence to P. F. Grima.

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Grima, P.F., Chiavaroli, R. & Grima, P. Ultrasonographic assessment of lipodystrophy in HIV-1-infected patients. Radiol med 114, 141–151 (2009). https://doi.org/10.1007/s11547-008-0333-y

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  • DOI: https://doi.org/10.1007/s11547-008-0333-y

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