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Open Access Highly Accessed Research article

Adipokines, hormones related to body composition, and insulin resistance in HIV fat redistribution syndrome

Paula Freitas1*, Davide Carvalho1, Ana Cristina Santos23, António José Madureira4, Esteban Martinez5, Jorge Pereira6, António Sarmento7 and José Luís Medina1

Author Affiliations

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

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

3 University of Porto Institute of Public Health, Porto, Portugal

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

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

6 Nuclear Medicine Department, Hospital de São João, Porto, Portugal

7 Infectious Diseases Department, Hospital de São João and University of Porto Medical School, Porto, Portugal

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BMC Infectious Diseases 2014, 14:347  doi:10.1186/1471-2334-14-347

Published: 23 June 2014

Abstract

Background

Lipodystrophies are characterized by adipose tissue redistribution, insulin resistance (IR) and metabolic complications. Adipokines and hormones related to body composition may play an important role linking these alterations. Our aim was to evaluate adipocyte-derived hormones (adiponectin, leptin, resistin, TNF-α, PAI-1) and ghrelin plasma levels and their relationship with IR in HIV-infected patients according to the presence of lipodystrophy and fat redistribution.

Methods

Anthropometric and metabolic parameters, HOMA-IR, body composition by DXA and CT, and adipokines were evaluated in 217 HIV-infected patients on cART and 74 controls. Fat mass ratio defined lipodystrophy (L-FMR) was defined as the ratio of the percentage of the trunk fat mass to the percentage of the lower limb fat mass by DXA. Patient’s fat redistribution was classified into 4 different groups according the presence or absence of either clinical lipoatrophy or abdominal prominence: no lipodystrophy, isolated central fat accumulation (ICFA), isolated lipoatrophy and mixed forms (MXF). The associations between adipokines levels and anthropometric, metabolic and body composition were estimated by Spearman correlation.

Results

Leptin levels were lower in patients with FMR-L and isolated lipoatrophy, and higher in those with ICFA and MXF. Positive correlations were found between leptin and body fat (total, trunk, leg, arm fat evaluated by DXA, and total, visceral (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio evaluated by CT) regardless of FMR-L, and with HOMA-IR only in patients with FMR-L. Adiponectin correlated negatively with VAT, and its mean levels were lower in patients with ICFA and higher in those with no lipodystrophy. Resistin was not correlated with adipose tissue but positively correlated with HOMA-IR in FMR-L patients. PAI-1 levels were higher in MXF-patients and their levels were positively correlated with VAT in those with FMR-L. Ghrelin was higher in HIV-infected patients than controls despite BMI-matching.

Conclusion

The overall body fat reduction in HIV lipoatrophy was associated with low leptin plasma levels, and visceral fat accumulation was mainly associated with decreased plasma levels of adiponectin.

Keywords:
Lipodystrophy; HIV; Adipokines; Body composition; Insulin resistance