Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPeB7339-ThPeB7342 419

Results: Despite the similarities in age, race, BMI, and menopausal status, HIV
infected women had almost twice the amount of visceral abdominal adipose tissue. HIV infected Caucasian women had significantly lower bone mineral content
than their non-infected counterparts.

Variable
Subcutaneous abdominal adipose
tissue (CT)
Visceral abdominal adipose tissue (CT)
Bone mineral (DXA) All subjects
Bone mineral (DXA) Caucasians

HIV+ Women HIV- Women p value

24242 ~ 10458 cm2
10416 ~ 4776cm2
2328 ~ 383
2178~ 315g

18818 ~ 9310cm2
5543 ~ 3651cm2
2446 ~ 294
2411~ 259

0.099.0009.27.03

Conclusions: The management of troubling side effects such as lipodystrophy
and osteoporosis has taken on new importance in HIV care and underscores the
need to examine strategies that may attenuate or alleviate these side effects. Use
of common measures of lipodystrophy syndrome, along with DXA technology to
assess bone density, may need to be incorporated into routine management of
HIV infected patients.
Presenting author: Barbara Smith, 105 Kingsley Court, Alabaster, Alabama,
35007, United States, Tel.: [phone], Fax: [phone], E-mail:
smithb @ son.uab.edu
ThPeB7339 The effects of a diet and exercise weight loss
program in obese HIV-infected women
E.S. Engelson1, D. Agin2, S. Kenya1, Q. He1, B. Luty1, G. Werber-Zion2,
J. Wang 1, S.B. Heymsfield1, J.B. Albu1, D.PR Kotler1. 1'St Luke's-Roosevelt
Hospital Center/Columbia University, New York, NY United States; 2York
College, City University of New York, New York, NY United States
Background: Obesity, with and without fat redistribution and metabolic changes,
is increasingly common in HIV-infected individuals in the US, especially since
the availability of effective antiviral medications. In uninfected individuals, obesity
and similar body composition and metabolic states are associated with increased
risk of diabetes and cardiovascular disease, and intentional weight loss improves
these parameters. It is unknown what effects intentional weight loss might have
in the context of HIV infection, nor if these effects would differ in the presence or
absence of fat redistribution.
Methods: Ten clinically stable obese HIV+ women of an intended 30 have completed a 12-week diet and exercise program. The diet is 1200 kcal, 50% carbohydrate, 30% fat and 20% protein. The exercise is a combined aerobic and resistance program. Before and after the intervention, body composition is measured
by anthropometry, dual energy x-ray absorptiometry (DXA) and whole body magnetic resonance imaging (MRI). Metabolic measurements, completed in 5 women,
include fasting glucose and insulin, and insulin sensitivity (SI) by frequently sampled intravenous glucose tolerance test.
Results are presented in the table below (all as mean~standard deviation).
Conclusions: With a combined low calorie diet and exercise program, significant
loss of lean tissue including skeletal muscle may be prevented during intentional
weight loss in obese HIV+ women. However, significant loss of total weight and
visceral fat, and reduction in waist circumference, all associated with greater insulin resistance and cardiovascular disease, may not improve insulin sensitivity in
the context of HIV disease and treatment.
Presenting author: Ellen s. Engelson, Room S&R 1301, St. Luke's-Roosevelt
Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, United States,
Tel.: [phone], Fax: [phone], E-mail: eengelson @ slrhc.org
ThPeB7340 Does lipodystrophy affect quality of life?
G. Orlando1, G. Guaraldi1, R. Murri2, A. Wu3, G. Nardini1, B. Beghetto1,
G.K. Sterrantino4, S. Sbaragli4, M. Borderi5, S. Talbs, C. Grosso6, C. Erba7,
A.M. Cattelan8, A. Antinori9, R. Esposito1. 1Universita di Modena, Clinica
Malattie /nfettive, via del Pozzo, 71, 41100, Modena, Italy; 2Universita Cattolica,
Roma, Italy; 3John Hopkins University, Baltimore, United States; 40spedale
Carreggi, Firenze, Italy; 5Ospedale S. Orsola, Bologna, Italy; 60spedale di
Cesena, Cesena, Italy; 7Universita di Parma, Parma, Italy; 8Ospedale di Padova,
Padova, Italy; 9/RCCS Spallanzani, Roma, Italy
Background: Increases in life expectancy of people with HIV makes it important
to consider quality of life (QOL) as an outcome of HAART. Lipodystrophy (LD) has
the potential to affect patients' QOL, but little is known about this impact.
We examined the QOL of HIV+ patients with and without lipodystrophy.
Methods: In a cross sectional study (N=175), we evaluated the presence of
lipodystrophy syndrome and functional status and psychological well-being using
the MOS-HIV Health Survey (Wu-1991), which includes physical function, pain,
social and role functioning, energy, emotional status, cognitive functioning and
perceived health.

Results: 105 (59.8%) patients were male and 70 (40.2%) were female. Mean
CD4+ cell count was 543 (~305); 35% of people had undetectable HIV RNA;
mean duration of HAART was 50 months (~31.5); 83 people (47.4%), met MACS
definition of LD. Of these, 45 reported that body changes had been present for
>12 months. In bivariate analysis LD patients had significantly lower score than
no LD patients' physical functioning [LD 74.9 (23.1) vs no LD 85.6 (20.9) respectively, p=0.003], role functioning [LD 74.4 (25.9) vs no LD 84.8 (23.7) p=0.008]
and physical health summary score [LD 50.4 (8.0) vs no LD 53.4 (7.6) p=0.01].
In multivariate analysis adjusted for sex, CDC group, HIV-RNA value, non adherence role functioning remained significantly lower in people with LD (p=0.006).
Conclusions: Lipodystrophy was related to lower QOL. Diminished role functioning may be due to stigma. Measures of quality of life can be useful to establish
the impact of treatment and disease in people living with HIV.
Presenting author: Giovanni Guaraldi, Clinica Malattie Infettive, via del Pozzo,
71, 41100, Modena, Italy, Tel.: [phone], Fax: [phone], E-mail:
g.guaraldi @ unimo.it
ThPeB7341 The impact of HIV-associated adipose
redistribution syndrome on psychological
well-being and quality of life: A cross-sectional
survey
M.A. Testa1, M. Thompson2, R.R. Turner3, N. Muurahainen4, J.M. Gertner5.
'Harvard School of Public Health, Boston, MA, United States; 2AIDS Research
Consortium of Atlanta, Dept Biostatistics, Harvard School of Public Health, 655
Huntington Avenue, Boston, MA, United States; 3Phase V Technologies,
Wellesley Hills, MA, United States; 4Serono Laboratories, Inc., Rockland, MA,;
5Serono Laboratories, Inc., Rockland, MA, United States
Background: HIV-associated Adipose Redistribution Syndrome (HARS) may
substantially affect self-concept, body image, perceived functional capacity, and
psychological well-being. In turn, this may serve as a disincentive to patient adherence and willingness to begin antiretroviral therapy.
Methods: During a multicenter trial, questionnaires were administered before
randomization to growth hormone. Quality of life (QOL), psychological well-being
(PWB), distress regarding appearance (DIS), and appearance interference with
functional activities (INF) were evaluated. For all scales, higher scores were better.
Results: The 299 HARS-diagnosed subjects were 84% male, 79% Caucasian
and aged 45~7 yrs. Subjects reported their appearance (3.6~1.3) as "quite upsetting and distressing". Fifty percent reported that their appearance interfered
with their functioning "some of the time" or more (4.2~1.3). INF correlated generally higher with the nine PWB scales (average r=0.37) and QOL (0.38) than
did DIS (0.16, 0.13). For DIS and INF, women (2.8~10.8, 3.6~1.3) had significantly lower scores than men (3.7~0.9, 4.3~1.2), p<0.0001. There were no gender differences in quality of life. Groups formed by median split on DIS and INF
scores were different on psychological well-being and quality of life (multivariate
p-values<0.0001) and univariate scores (p-values <0.01). The greatest impact
was on emotional ties while the least was on behavioral/emotional control.
Conclusions: While antiretroviral therapy has produced significant benefits in
disease progression, it has been accompanied by disturbing morphological and
metabolic changes. Patient evaluation of these changes indicates a high level of
distress and interference, particularly for women, that diminishes psychological
well-being and quality of life and may serve as a significant barrier to beginning
and adhering to antiretroviral therapy.
Presenting author: Marcia Testa, Dept. Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA, United States, Tel.: [phone], Fax: [phone], E-mail: testa@ hsph.harvard.edu
ThPeB7342 The triglyceride-lowering effect of omega-3 fatty
acids in HIV-infected patients on HAART
D. Peabody, V. Remple, T. Green, A. Kalmar, J. Frohelich, J. DeWet, D. Burdge.
Children's and Women's Health Centre of British Columbia, University of British
Columbia, Vancouver, BC, Canada
Background The objectives of this double-blind, randomized, placebo-controlled
clinical trial were to identify the effect of omega-3 fatty acid (n3) supplementation
and diet counseling on sero-lipids (SL), including triglycerides (TG), cholesterol
(chol), HDL, and LDL, in HIV-infected adults on HAART.
Methods: At recruitment subjects had TG > 3 mmol/dl. Diet counseling was given
at baseline. At wk 4 subjects were randomized to 300 mg n3/day or placebo (olive
oil). Diet and SL data were collected at wks 0, 4, 12. Clinical/immunologic data
were obtained by chart review. Food Processor VI was used for diet analysis.
Statistical analyses included t tests, Fisher's and repeated measures ANOVA.
Results: Thirty-four subjects had diet counseling of whom 28 (21 male) completed the n3 protocol. At baseline mean age was 42 yrs (31-56); BMI 24.9 (18 -
Abstract ThPeB7339 - Table
Weight, kg Waist C, cm DXA fat, % MRI SM, L MRI SAT, L MRI VAT, L Glucose, mg/dL Insulin, tm/mL SI
Pre 87.7~7.8 102.2~88.2 39.7~8.9 23.4~3.1 40.3~8.3 3.7~0.8 106.4~16.4 33.0~24.8 0.7~0.6
Post 81.6~7.1 98.1~77.1 35.7~8.6 22.7~3.5 34.4~7.4 2.9~0.5 94.9~12.3 28.3~27.6 0.9~1.2
p 0.0005 0.02 0.002 0.07 0.0008 0.0005 0.11 0.18 0.78
C=circumference; WHR=waist:hip ratio; SM=skeletal muscle; SAT=subcutaneous adipose tissue; VAT=visceral AT.