Antiretroviral Therapy Initiation Is Associated With Decreased Visceral and Subcutaneous Adipose Tissue Density in People Living With Human Immunodeficiency Virus

Clinical Infectious Diseases, February 2020

Disturbances in adipose tissue (AT), also known by the general public as “fat,” in people living with HIV include lipodystrophy (fat loss or gain) and obesity. AT quality, in addition to quantity, are closely associated with the development of cardiovascular disease. AT quality can be indirectly assessed by quantifying AT density (in Hounsfield units, HU) on computed tomography (CT); decreases in AT density suggest disrupted adipocyte function. Limited studies have explored the relationship between AT quality and antiretroviral therapy (ART). A5260s is a prospective substudy of a phase 3 randomized clinical trial (A5257) that investigated NNRTI-sparing regimens for the initial treatment of HIV. Investigators in A5260s sought to describe the effects of ART initiation on visceral AT (VAT) and subcutaneous AT (SAT) density, and to determine relationships between AT density and circulating inflammatory biomarkers on cardiovascular disease.

The participants of A5260s were initiated on ART in the context of A5257 for 96 weeks. Both SAT and VAT density decreased after 96 weeks of treatment with women having larger decreases. Less dense AT also correlated with greater disruptions of lipid and glucose metabolism. For instance, decreases in VAT and SAT density correlated with decreases in adiponectin levels and increases in leptin levels, both of which have been associated with greater cardiometabolic risk. These findings suggest that ART leads to changes in AT density (independent of AT quantity), which may have deleterious effects on cardiovascular risk.

Debroy, P., Lake, JE., Moser, C., Olefsky, M., Erlandson, KM., Scherzinger, A., Stein, JH., Currier, JS., Brown, TT., and McComsey, GC. ART initiation is associated with decreased visceral and subcutaneous adipose tissue density in people living with HIV.  Clinical Infectious Diseases 2020 Feb. doi 10.1093/cid/ciaa196