Open Access Research article

Lipodystrophy defined by Fat Mass Ratio in HIV-infected patients is associated with a high prevalence of glucose disturbances and insulin resistance

Paula Freitas1*, Davide Carvalho2, Ana Cristina Santos3, Joana Mesquita4, Maria João Matos5, Antonio Jose Madureira6, Esteban Martinez7, António Sarmento8 and José Luís Medina9

Author Affiliations

1 Department of Endocrinology, Hospital de São João, University of Porto Medical School, Alameda Hernâni Monteiro, 4200, Porto, Portugal, Portugal

2 Department of Endocrinology, Hospital de São João, University of Porto Medical School, Porto, Portugal

3 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, and University of Porto Institute of Public Health, Porto, Portugal

4 Department of Endocrinology, Hospital de São João, University of Porto Medical School, Porto, Portugal

5 Department of Endocrinology, Hospital de São João, University of Porto Medical School, Porto, Portugal

6 Department of Radiology, Hospital de São João, University of Porto Medical School, Porto, Portugal

7 Department of Infectious Diseases, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain

8 Department of Infectious Disease, Hospital de São João, University of Porto Medical School, Porto, Portugal

9 Department of Endocrinology, Hospital de São João, University of Porto Medical School, Porto, Portugal

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BMC Infectious Diseases 2012, 12:180  doi:10.1186/1471-2334-12-180

Published: 6 August 2012

Abstract

Introduction

Combined antiretroviral therapy (cART) in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes.

Aims

To compare the prevalence of glucose homeostasis disturbances and IR in HIV patients on cART according to the presence of lipodystrophy (defined clinically and by Fat Mass Ratio) and different patterns of fat distribution and to establish their associations.

Design

Cross-sectional cohort study.

Methods

We evaluated body composition and IR and insulin sensitivity indexes in 345 HIV-infected adults.

Results

Patients with clinical lipodystrophy (CL) had higher plasma glucose levels than patients without CL, without significant differences in plasma insulin levels, A1c, HOMA-IR, HOMA-B, QUICKI, or MATSUDA index. Patients with lipodystrophy defined by FMR had higher plasma glucose and insulin levels, A1c, HOMA-IR, QUICKI and MATSUDA than patients without lipodystrophy, without differences in HOMA-B. Higher insulin resistance (HOMA-IR ≥ 4) was present in patients with FMR-defined lipodystrophy. Patients with FMR-defined lipodystrophy had a higher prevalence of IFG, IGT and DM than patients without lipodystrophy. Significant associations between HOMA-IR and total, central and central/peripheral fat evaluated by CT at abdominal level were found and no association between HOMA-IR and peripheral fat. Association between HOMA-IR and total and trunk fat but no association with leg and arm fat (evaluated by DXA) was found.

Conclusions

IR and glucose disturbances were significantly increased in patients with FMR-defined lipodystrophy. FMR lipodystrophy definition seems to be a more sensitive determinant of insulin resistance and glucose disturbances than clinical definition.

Keywords:
Lipodystrophy; Insulin resistance; HIV; Glucose homeostasis disturbances