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

XIV International AIDS Conference

Abstracts ThPeB7355-ThPeB7359 423

were obtained in the 3 arms. However, no significant changes in IR were observed. Body composition changes will also be presented
Presenting author: Emilio Fumero, Hospital de Bellvitge. Feixa LLarga s/n.
Hospitalet de LLobregat. Barcelona, Spain, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7355 Risk of lipodystrophy in HIV-1-infected patients
receiving highly active antiretroviral therapy not
containing protease inhibitors: a prospective
cohort study
E. Martinez, A. Milinkovic, M. Garcia, J.B. Perez-Cuevas, J.L. Blanco, J. Murillas,
M. Lonca, J. Mallolas, J.M. Gatell. Hospital Clinic, Barcelona, Spain
Methods: Prospective cohort study including consecutive antiretroviral naive HIV1-infected patients that were prescribed antiretroviral therapy including 2 nucleoside reverse transcriptase inhibitors (NRTI) plus either a non-NRTI (nevirapine,
NVP; efavirenz, EFV) or a third NRTI. Moderate or severe body fat changes
through a standardised questionnaire, fasting plasma values of glucose, triglycerides, cholesterol, CD4 cells, and plasma HIV-1 RNA were assessed at least
every 3 months until the development of lipodystrophy, death, lost to follow-up or
discontinuation of NNRTIs whichever came first.
Results: Two hundred and sixty-one patients were included. Patients were predominantly men (70%) and HIV-1 infection had been predominantly acquired
through sexual contact (71%). In 284 patient-years, 6 (2%) patients died, 52
(19%) were lost or censored due to the inclusion of protease inhibitors, and 20
(7%) developed lipodystrophy. Body fat changes included lipoatrophy in all 20
patients (100%) plus central obesity in 8 (40%). Median (IQR) time until lipodystrophy was 15 months (12-22). The proportions of patients with NVP (55%), EFV
(30%), or a third NRTI (15%) were similar in patients developing and not developing lipodystrophy, whereas the proportion of patients with d4T was higher in
those developing lipodystrophy (80%) than in those not (58%) (p<0.05). Patients
developing lipodystrophy were older, had higher increase in CD4 cells, and had
longer exposure to ddl, 3TC, d4T, and to antiretroviral therapy as a whole.
Conclusion: Lipodystrophy in HIV-1 -infected patients receiving highly active antiretroviral therapy not containing protease inhibitors consists mainly of lipoatrophy. Risk factors shared similarities with those ones described for regimens containing protease inhibitors.
Presenting author: esteban martinez, hospital clinic, villarroel 170, piso 4 esc
4, barcelona8036, Spain, Tel.: [phone], Fax: [phone], E-mail:
esteban @ intercom.es
ThPeB7356 Insulin sensitivity and body composition in obese
HIV+ women
J.B. Albu, E.S. Engelson, S. Kenya, A. Kovera, M. Littschwager, M. Wainright,
D.P. Kotler. St.Luke's/Roosevelt Hospital Center, Columbia Univ, New York, NY,
United States
Background: HIV+ people are experiencing decreased insulin sensitivity (SI) and
increased visceral adipose tissue (VAT). How SI compares to similar HIV- populations and whether the changes reverse with weight loss is not known.
Methods: We measured fasting insulin (Fl) and SI by IVGTT (minimal model) in
13 HIV+ and 20 HIV- obese non-diabetic Black and Hispanic women. Fat mass
(FM) was measured by dual energy x-ray absorptiometry (DXA) in 9 HIV+ and
14 HIV- women, and whole body subcutaneous and visceral adipose tissue (SAT
and VAT) were measured by magnetic resonance imaging (MRI) in 5 HIV+ and
11 HIV-. Five HIV+ also completed a diet and exercise weight loss program. Statistical analysis is by paired t-test.
Results: HIV+ and HIV- age and BMI were similar (mean~SD, 40~7.6 vs 39~5.1
and 34.5~2.8 vs 32.9~4, respectively). HIV+ women had higher FI and lower SI
than HIV- (17.7~5.5 vs 13.3~6.6, p=0.06 and 1.5~1.3 vs 3.0~1.7, p<0.05). SI
was lower in HIV+ even after adjusting for BMI. We did not adjust for FM or SAT
because of significant interactions (p<0.05 for all). Specifically, FI increased and
SI decreased with increased FM and SAT in HIV-, while FI increased and SI decreased with decreased FM and SAT in HIV+ women. The relationship between
VAT and SI was similar in the 2 groups but SI was lower in HIV+ even after adjusting for VAT (p<0.05). SI did not improve (p=0.8) in the women who completed
the weight loss program despite significantly decreased fat mass (29.7~11.1 vs
23+8.8 kg, p=0.06) and VAT (3.2~0.6 vs 2.6~0.5 kg, p=0.005).
Conclusion: Insulin resistance and increased fasting insulin are not related to
increased fat mass in obese HIV+ women. Furthermore, it is unclear if fat loss will
improve insulin sensitivity in these women.
Presenting author: Jeanine Albu, 1111 Amsterdam Avenue, wh-10, New York,
NY, 10025, United States, Tel.: [phone], Fax: [phone], E-mail: jbal
@columbia.edu

ThPeB7357 Studies of subcutaneous adipose tissue (SAT) in
HIV+ subjects with and without lipodystrophy
J. Johnson, J.B. Albu, E.S. Engelson, G. lonescu, J. Sheikhan, D.R Kotler.
St.Luke s/Roosevelt Hospital Center, Columbia Univ, New York, United States
Background:The etiology of HIV-associated lipodystrophy is multifactorial. In ad
dition to highly active antiretroviral therapy, immune dysregulation has been proposed as an etiologic factor. We tested the hypothesis that lipoatrophy is associated with metabolic alterations in SAT.
Methods: Aspirations of subcutaneous abdominal tissue (SAT) were performed
in 56 subjects, 28 with fat redistribution (HIVL+), 16 HIV+ without (HIVL-) and 12
controls. Buffalo humps (BH) were aspirated in 8 HIVL+. Aspirates were incubated
for 3 hours, and the release of TNFo, IL-6, lactate, and glycerol into the medium
were measured. Group differences were analyzed by ANOVA and Scheffe, SAT
and BH were compared by paired t-test, and associations among the variables
were explored.
Results: The groups differed in visceral adipose tissue (VAT; p<.005) and SAT
(p=.02), with HIVL+ having significantly more VAT than HIVL-, and HIV- having
significantly less SAT than controls. Glycerol (p<.05) and lactate (p=.03) secretion
differed by group, and were elevated in both HIV+ groups compared to controls.
The secretion of glycerol and lactate correlated with each other (r=.41, p=.0028).
TNF secretion differed by group (p=.02) and was significantly higher in HIVL+ than
in HIVL-. Serum concentrations of sTNF receptor 2 differed by group (p=.016) and
were significantly higher in HIVL+ than in controls. IL-6 secretion did not differ, but
IL-6 secretion correlated with both TNF release (r=.43, p=.005) and sTNFr2 (r=.6,
p<.001). The secretion of glycerol (p<.07), lactate (p=.06), and TNF (p=.04) all
were higher in SAT than in BH.
Conclusion: These preliminary studies suggest that SAT metabolism is altered
in several ways in HIV infection. Elevations in lipolytic rates may be related to
HIV infection or its treatment. Some patients with lipodystrophy appear to have
immune dysregulation with local and systemic increases in proinflammatory cytokine activity.
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: [email protected]
ThPeB7358 Comparison of bioimpedance analysis and
anthropometrics in the estimate of truncal fat
Q. He, J. Wang, E.S. Enelson, D.R Kotler. St Luke's-Roosevelt HospitaldCenter,
College of Physicians & Surgeons, Columbia University, New York, United States
Introduction: Upper body obesity is common in HIV-related lipodystrophy and is
associated with adverse health outcomes.
There are several methods available to estimate regional adipose tissue ranging
from sophisticated imaging techniques to anthrompometry.
We examined the relationship between truncal adipose tissue (AT) and a modified
bioimpedance analysis (BIA) method.
Method: Studies were performed in HIV+ men (n=12; BMI=26.1~1.7 kg/m2) and
women (15; 32.2~4.8 kg/m2).
Resistance and reactance were measured across the trunk (TRK, anterior superior iliac spine to sternoclavicular joint) and abdomen (ABD, anterior superior
iliac spine to xiphoid process) using a single frequency BIA (Quantum 10, RJL
system, MI, USA) and both 2-inch and 10-inch electrodes.
Total body MRI scans and anthropometry were performed. Regression and Bland
Altman methods were used.
Result: Total TRK and ABD AT (TAT) by MRI were 13.7~6.2 and 8.8~4.0 L, respectively.
Subcutaneous AT (SAT) was 10.7~6.0 and 6.2~3.8 L.
Visceral AT (VAT) was 3.0~1.1 and 2.6~0.9 L.
Corresponding impedance was 57.1~18.4 and 48.1~16.9 Ohms by 10-inch electrodes, and 109.2~31.4 and 110.9~36.4 Ohms by 2-inch electrodes, respectively.
Waist circumference was 96.0~9.5 cm.
Multiplication of length and waist circumference was strongly correlated with TRK
TAT (r2=0.75) and ABD TAT (r2=0.75) but not VAT (r2=0.1-0.2).
Bland Altman method showed there was no systematic bias.
Only impedance by 2-inch electrodes at ABD on males had a similar coefficient
of determination(r2 =0.76) as waist circumference.
Conclusion: BIA does not add to the predictive value of anthropometry for estimating truncal and abdominal fat.
Presenting author: Qing He, S & R Building, Rm. 1301, St. Luke's-Roosevelt
Hospital Cental, 1111 Amsterdam Avenue, New York, NY 10025, United States,
Tel.: [phone], Fax: [phone], E-mail: qinghe@ hotmail.com
ThPeB7359 CSF cytokine profile in HIV seropositive patients
with Tuberculous Meningitis
A.I. Bhigjee1, V.B. Patel1, C. Connoly2, PL.A. Bill1. 1Dept of Neurology,
University of Natal, Dept of Neurology Wentworth Hospital, Private Bag, Jacobs
4026, South Africa; 2MRC South Africa, Durban, South Africa
Background: Both Thi and Th2 type cytokine responses have been observed in
Tuberculous meningitis (TBM). Whether a different cytokine response occurs in
HIV seropositive patients with TBM is unknown.

Methods: The CSF cytokine profile was studied in 17 HIV positive and 10 HIV
negative patients with TBM. TNF alpha, IFN gamma and IL10 were measured
using commercial ELISA kits. Patients were also stratified according to severity
of TBM using the MRC grading scale. The cytokine results were also correlated
with ADA levels and CD4 counts in the CSF The Wilcoxin rank sum test and the
Spearman rank correlation test were used for statistical analysis.
Results: There was no significant difference in the CSF levels of IFN gamma,