Endocrinology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal.
J Clin Densitom. 2010 Apr-Jun;13(2):197-203. doi: 10.1016/j.jocd.2010.01.005. Epub 2010 Mar 27.
Human immunodeficiency virus (HIV) infection and its treatment with antiretroviral therapy (ART) have been associated with lipodystrophy. Different clinical methodologies have been used to define the syndrome. The aim of this study was to propose gender-specific reference values using objective measurements for defining lipodystrophy in HIV-infected patients. Using dual-energy X-ray absorptiometry (DXA), total body composition was analyzed in 221 HIV-infected patients under ART (146 men). We used fat mass ratio (FMR) as the ratio between the percent of the trunk fat mass and the percent of the lower-limb fat mass. One hundred forty patients (63.6%) presented clinically defined lipodystrophy. In men, the optimal cutoff value for the FMR was 1.961 (area under the receiver operating characteristic curve [AUC]: 0.74 [95% confidence interval (CI): 0.66-0.82], p<0.001), with a sensitivity 58.3%, a specificity 83.7%, a positive predictive value (PPV) of 89.6% and a negative predictive value (NPV) of 45.5%. In women, the optimal cutoff value for the FMR was 1.329 (AUC: 0.74 [95% CI: 0.63-0.86], p<0.001), with a sensitivity 51.4%, a specificity 94.6%, a PPV of 90.5%, and an NPV of 66.0%. The FMR evaluated by DXA with the gender-specific cutoffs defined here is an objective way to define HIV-related lipodystrophy.
人类免疫缺陷病毒（HIV）感染及其抗逆转录病毒治疗（ART）与脂肪营养不良有关。已经使用不同的临床方法学来定义该综合征。本研究的目的是使用客观测量来为 HIV 感染患者定义脂肪营养不良，并提出性别特异性参考值。使用双能 X 射线吸收法（DXA）分析了 221 名接受 ART 治疗的 HIV 感染患者（146 名男性）的全身成分。我们使用脂肪质量比（FMR）作为躯干脂肪质量百分比与下肢脂肪质量百分比的比值。140 名患者（63.6%）表现出临床上定义的脂肪营养不良。在男性中，FMR 的最佳截断值为 1.961（接受者操作特征曲线下面积 [AUC]：0.74 [95%置信区间：0.66-0.82]，p<0.001），敏感性为 58.3%，特异性为 83.7%，阳性预测值（PPV）为 89.6%，阴性预测值（NPV）为 45.5%。在女性中，FMR 的最佳截断值为 1.329（AUC：0.74 [95%置信区间：0.63-0.86]，p<0.001），敏感性为 51.4%，特异性为 94.6%，PPV 为 90.5%，NPV 为 66.0%。使用 DXA 评估并根据这里定义的性别特异性截止值，FMR 是一种定义 HIV 相关脂肪营养不良的客观方法。
