Dual-energy X-ray absorptiometry in the early diagnosis of body shape changes in patients with HIV infection treated with nucleoside reverse transcriptase inhibitors and naive to protease inhibitors

Background: Antiretroviral therapies based on 2 nucleoside reverse transcriptase inhibitors (NRTIs) in combination with protease inhibitors (PIs) have been shown to increase CD4 T-cell counts and induce clinical improvement in HIV-infected patients, with plasma virus suppression. PIs, however, may induce hyperlipidemia, insulin resistance, fat redistribution, and lipoatrophy. It has been suggested that lipoatrophy and fat redistribution may also occur in PI-naive patients treated with NRTIs. Objective: The aim of this study was to evaluate body composition alterations in HIV-infected patients at various stages of the disease using dual-energy x-ray absorptiometry (DEXA). Methods: Fat total, lean total, and bone mineral density of the whole body and subregions (limbs and trunk), as assessed by DEXA analysis of body composition, were compared between a group of HIV-infected patients and a control group matched for age, sex, and height. Results: Twenty-five white male patients (mean age, 38.48 years) were enrolled; 23 had been treated with NRTIs but not with PIs. DEXA analysis showed a significant loss of subcutaneous adipose mass in the limbs and trunk in the HIV-infected group (P less than or equal to 0.013 vs control group), without any other metabolic or hematologic abnormalities. Lean total and bone mineral density were not significantly different in the 2 groups. Conclusions: Thinning of the extremities without metabolic changes or fat redistribution may indicate an initial lipoatrophy in those patients treated with NRTIs; DEXA is an effective way to reveal and quantify these body changes at an early stage.