Unit of Pharmacy, Paule de viguier Hospital, Toulouse, France.
J Clin Densitom. 2010 Apr-Jun;13(2):237-44. doi: 10.1016/j.jocd.2009.12.004. Epub 2010 Mar 27.
The aim of this study was to define evolution profiles of body composition among human immunodeficiency virus (HIV)-infected men with lipodystrophy. The design is a retrospective analysis using observational data collected longitudinally. We included 101 HIV-infected men with lipodystrophy managed in routine practice and who had 2 dual energy X-ray absorptiometry scans within a minimum interval of 18 mo. Lipodystrophy was defined as a fat mass ratio (FMR, defined as the ratio of the percentage of the trunk fat mass over the percentage of the lower limbs fat mass) equal or superior to 1.5. Patients were classified in "improved" group (IG: increase of lower limbs fat mass >/= 10%) or "nonimproved" group (NIG). Body composition, immunovirological and epidemiological data were collected and compared between the 2 groups. In the whole population, over a 4-yr period, a significant increase was observed for total fat mass, trunk fat mass, and lower limbs fat mass, whereas total lean mass was stable. Total body mineral density decreased. Fifty-nine patients (IG), less exposed to zidovudine than the NIG, had an increase of lower limbs fat mass higher than 10%. But only 13 (22%) regained a normal distribution of fat mass (FMR < 1.5), showing that lipodystrophy was slowly reversible. Among the NIG, 5 patients (11.9%), less exposed to zidovudine and with a higher mean of viral load, reached an FMR below 1.5. It was mainly because of a loss of trunk fat mass, which could be the sign of a lipodystrophy worsening. Lipodystrophy improved for 58.4% of men. The improvement was very slow. Recovery was observed only in patients with an earlier intervention. No correlation was observed between lipodystrophy and total body bone mineral density. The loss of trunk fat mass without gain of lower limbs fat mass may indicate a worsening of HIV disease.
本研究旨在明确脂肪营养不良的 HIV 感染者的体成分演变特征。该研究设计为回顾性分析，采用纵向观察性数据。共纳入 101 例脂肪营养不良的 HIV 感染者，在 18 个月的最小间隔内进行了 2 次双能 X 线吸收法扫描。脂肪营养不良定义为脂肪质量比（FMR，定义为躯干脂肪质量百分比与下肢脂肪质量百分比之比）等于或大于 1.5。将患者分为“改善组”（IG：下肢脂肪质量增加≥10%）和“未改善组”（NIG）。收集两组患者的体成分、免疫病毒学和流行病学数据并进行比较。在整个研究人群中，4 年内总脂肪量、躯干脂肪量和下肢脂肪量均显著增加，而总的瘦体重保持稳定。总的身体矿物质密度降低。59 例（IG）接受齐多夫定治疗的暴露量少于 NIG，下肢脂肪量增加超过 10%。但只有 13 例（22%）恢复了正常的脂肪质量分布（FMR<1.5），表明脂肪营养不良是缓慢可逆的。在 NIG 中，5 例（11.9%）接受齐多夫定治疗的暴露量较少且病毒载量较高的患者达到了 FMR<1.5。这主要是因为躯干脂肪量的减少，可能是脂肪营养不良恶化的迹象。58.4%的男性脂肪营养不良得到改善。改善非常缓慢。只有早期干预的患者才能恢复。脂肪营养不良与全身骨矿物质密度无相关性。躯干脂肪量的减少而下肢脂肪量无增加可能提示 HIV 疾病恶化。
