Multidisciplinary Collaborative Integrated Management of Increasingly Prominent HIV Complications in the Post-cART Era

L Lin; TS Li


HIV Medicine. 2020;21(11):683-691. 

In This Article

Dual-energy X-ray Absorptiometry (DXA) was Recommended to Assess PLWH With Clinical Lipodystrophy

Lipodystrophy (LD) is commonly used to describe a common fat redistribution syndrome in PLWH, especially in patients receiving long-term cART. The abnormal distribution of fat in the whole body is the decrease of fat in the face, upper limbs, lower limbs and buttocks and/or the accumulation of fat in the abdomen, neck and back. The incidence of LD among PLWH varies according to race. Sex differences make men more likely to experience fat atrophy and women more likely to experience fat accumulation. Chinese male PLWH and LD comorbidity frequently showed a significant decrease in peripheral and central fat, decreased bone mineral content (BMC), and increased lean mass (LM).[29] Early detection and diagnosis of LD is important for PLWH; LD not only affects the appearance of the patient but may reduce the effectiveness of ART.[30] The fat mass (FM) of Chinese male PLWH was negatively correlated with the duration of HIV infection and the duration of cART. FM was positively correlated with body weight and BMC content and negatively correlated with LM content. HIV-infected males with LD have lower body and regional FMs and lumbar spine BMD compared with non-LD patients, and their body, trunk and leg BMC was also lower than those in healthy people.[29] We recommend that DXA measurement be used as an auxiliary objective examination to evaluate the changes of body composition in PLWH, and the indices of FM, LM, BMC and BMD could be measured for a comprehensive evaluation.

The d4T, considered as a HIV-LD-inducing medication, was discontinued due to severe abnormal fat distribution and atrophy. In patients who previously used D4T and didanosine as the backbone ART regimen, baseline CD4 cell levels and adiponectin levels were lower in HIV-LD patients than in HIV-NLD patients. The results showed that both the adiponectin concentration at baseline and the adiponectin change rate at 18 months were risk factors for the development of HIV-LD.[31] The decrease of adiponectin may be related to the increased expression of the tumour necrosis factor (TNF)-α gene in the subcutaneous fat, which inhibits the expression of the adiponectin gene and secretion of fat cells in vitro.[32]