Comparer l’évolution des marqueurs du métabolisme osseux et de la DMO chez des patients débutant un traitement ARV. Nous avons réalisé une étude prospective comparative chez 72 patients infectés par le VIH débutant un traitement comprenant 2 INTI, + 1 INNTI ( n = 36) ou 1 IP ( n = 36). À l’inclusion (M0) et à M6, M9 et M21, des dosages des marqueurs du métabolisme osseux étaient effectués. À M0, M9 et M21 était réalisée une exploration par DEXA. Entre M0 et M9, parmi les 38 patients évaluables (19 dans chaque gpe) on constatait, dès M6, une augmentation des valeurs des phosphatases alcalines osseuses (PAO), de l’ostéocalcine (OCN) et des b-cross-laps (b-CTx), avec une stabilisation à M21 [M21 vs M0 : PAO = 26 vs 8,2 mg/l ( p = 0,001), OCN = 24,8 vs 17,4 mg/l ( p = 0,001), b-CTx = 476 vs 326 mg/l ( p = 0,001)], sans différence entre les 2 gpes. À M21 par rapport à M0, il existait, dans les 2 gpes (sans différence significative intergroupe), une diminution des taux de 25-OH D3 [14,7 vs 20,3 mg/l ( p = 0,02)] et une augmentation des taux de 1-25 OH D3 et de PTH. [58,9 vs 48,6 ng/l ( p = 0,05) et 49,5 vs 34,6 ng/l ( p = 0,001)]. Sur le DEXA, on notait à M21 par rapport à M0 : une augmentation significative de la masse grasse totale et des membres, dans le gpe IP uniquement, [21,5 vs 18,4 kg ( p = 0,03) et 9,2 vs 7,3 kg ( p = 0,03)], et une diminution de la DMO L2-L4 dans les 2 gpes, significativement plus marquée dans le gpe IP [gpe IP : 1,186 vs 1,234 g/cm 2 ( p = 0,001) ; gpe NNTI : 1,230 vs 1,249 g/cm 2 ( p = 0,04)]. La mise en route d’une trithérapie ARV s’accompagne d’une elevation rapide et franche des paramètres du remodelage osseux. Dès M9, apparaît une baisse de la DM0 lombaire, plus importante chez les patients recevant des IP.

Décrire la composition corporelle de femmes infectées par le VIH et la comparer à celle de femmes non infectées. Étudier les facteurs associés à un index de répartition de la masse grasse (IRMG) et à la densité minérale osseuse (DMO). Étude transversale comparative de la composition corporelle de 160 femmes VIH (dont 139 traitées) et 214 femmes non infectées. Paramètres étudiés : stade de l'infection, durée de séropositivité, durée de traitement, nadir des CD4, taux de CD4, charge virale, temps d'exposition à chaque molécule antirétrovirale ; données de composition corporelle : DMO corps entier et L2-L4, masse grasse (MG) du tronc, des membres inférieurs (MI) et du corps entier, IRMG (% mg tronc/%MG MI), masse maigre des MI et du corps entier. Les femmes infectées par le VIH ont une DMO plus basse que les femmes non infectées à tous les sites de mesure. Les femmes VIH traitées ont une DMO L2-L4 plus basse que les femmes VIH non traitées (1,10 vs 1,18 g/cm2 ; p = 0,05). 8,7 % des femmes VIH traitées ont une ostéoporose, 38 % ont une ostéopénie. L'IRMG des femmes VIH traitées est supérieur à celui des femmes VIH non traitées (1,12 vs 0,93 ; p = 0,01)) et à celui des femmes non VIH (1,12 vs 0,84 ; p < 0,05). En analyse multivariée, seuls l'infection par le VIH et le fait d'être traité sont des facteurs associés à un IRMG supérieur à 1. Aucun lien n'est objective entre la DMO et un IRMG supérieur à 1. Ce travail confirme l'existence de troubles de la répartition de la masse grasse et d'une déminéralisation osseuse chez les femmes VIH. Il n'objective pas de relation entre la DMO et les modifications de la répartition de la masse grasse. Il propose une valeur seuil d'IRMG (> 1) signifiant une lipodystrophie densitométrique.

BACKGROUND:Human immunodeficiency virus (HIV) infection generally induces lipodystrophy. For targeted treatment a better understanding of its development is necessary. The utility of high-resolution magnetic resonance imaging (MRI) is explored.OBJECTIVES:The present study presents a way to visualize the adipose tissue architecture in vivo and to inspect modifications associated with the atrophy.METHODS:High-resolution MRI scans with surface coils were performed on the calf and at the lumbar region of three groups of patients: HIV patients with lipoatrophy, HIV patients without lipoatrophy and healthy volunteers. All patients underwent a clinical examination. In addition, dual energy X-ray absorptiometry (DEXA) measurements were taken. On the MRI scans adipose tissue thickness and adipose nodule size were measured. Results High-resolution MRI enabled identification of a clear disorganization of adipose tissue in patients with lipoatrophy. In addition, these patients presented a very small adipose tissue thickness on the calf and a very small nodule size.RESULTS:led to the hypothesis that adipose tissue disorganization appears before changes in DEXA measurements or clinically visible modifications.CONCLUSIONS:High-resolution MRI enabled visualization in vivo of precise changes in tissue organization due to HIV lipoatrophy. This imaging technique should be very informative for better monitoring of the atrophy.

The aim of this study was to establish the contribution of human immunodeficiency virus (HIV) itself on body composition changes evaluated by dual-energy X-ray absorptiometry (DXA). Body composition evaluated by DXA in 90 HIV never treated men, without comorbidity, or current or past opportunistic infections were compared with 241 healthy volunteers. The mean duration of seropositivity from HIV diagnosis was 41+/-62 mo, mean CD4 and viral load at the time of DXA were 402/mm(3)+/-263 (control values 500-1200/mm(3)) and 4.2 log copies/mL+/-1.3. Mean age (41 vs 39 yr, respectively, for HIV never treated patients and controls) and mean height (174.5 vs 176 cm) were not different, but mean weight was lower among HIV never treated patients (69.8 vs 78.7 kg). Mean total body bone mineral density (BMD) of naive HIV-infected patients was lower than that of controls (1.20 vs 1.23 g/cm(2), p=0.01) but not after adjustment on age, height, lean mass (LM), and fat mass ratio (FMR=% trunk fat mass/% lower limb fat mass). Fat mass (13.2 vs 16.5 kg, p<0.0001) and LM (53.5 vs 59 kg, p<0.0001) of naive HIV-infected patients were lower whatever the adjustment variables. The FMR was lower in naive HIV-infected men (1.0 vs 1.3, p<0.0001) because of a decreased trunk fat mass. After adjustment on age, height, LM, and fat mass, the lower limbs fat mass percentage was higher in HIV-infected men. The profile of naïve HIV-infected patients displayed low lean and fat masses, and a fat mass repartition characterized by a predominant loss in the trunk. Those alterations may result from the catabolic effect of the chronic HIV infection.

Study Objective. To determine whether discontinuation of stavudine or protease inhibitor therapy improves human immunodeficiency virus (HIV)-related fat distribution in men.Design. Observational, retrospective study consisting of a cross-sectional (part 1) and a longitudinal (part 2) study.Data Source. Medical records from Purpan University Hospital and La Grave University Hospital, Toulouse, France.Subjects. Eighty men with HIV infection treated with antiretrovirals and 151 healthy male controls matched for age.Measurements and Main Results. In part 1, body composition and fat distribution of the HIV-infected men were compared by dual energy x-ray absorptiometry (DEXA) with those of the controls to determine whether body fat distribution is altered in HIV-infected men. In part 2, we analyzed modifications of body composition and fat distribution in 45 of the 80 patients. These 45 had been exposed to antiretroviral drugs, including stavudine and a protease inhibitor, for at least 5 months before the first of two DEXA assessments. They received three different treatment strategies for several months. In group 1, stavudine was withdrawn; in group 2, protease inhibitor was discontinued, and in group 3, stavudine plus protease inhibitor were continued. Group 1 showed a significant fat gain in the lower extremities 31.7 +/- 5.9 months after stavudine discontinuation (p < 0.0001). Group 2 did not show any significant modification of total body, lower limb, or trunk fat despite protease inhibitor discontinuation for 35.2 +/- 6.6 months. Findings were similar for group 3, who continued receiving stavudine-protease inhibitor therapy for 21.2 +/- 12.8 months.Conclusion. These data suggest that long-term withdrawal of stavudine from the antiretroviral therapy regimen may be associated with significant improvement in lipoatrophy in the lower extremities, whereas long-term protease inhibitor withdrawal did not modify fat distribution.

The aim of this study was to define standard values for fat mass distribution by dual-energy X-ray absorptiometry in human immunodeficiency virus (HIV)-negative men and to analyze factors associated with lipodystrophy in HIV-infected men. Total-body composition was analyzed in 241 HIV-negative men (controls) and 162 HIV-infected men. We created a fat mass ratio (FMR) as the ratio of the percentage of the trunk fat mass to the percentage of the lower limbs fat mass. We defined the FMR standard values as the mean value +/- standard deviation. We compared body mass index (BMI), fat mass percentage (%FM), lean mass (LM), bone mineral density (BMD), and FMR between the control group and HIV-infected men, by age range, according to prescription of treatment and presence of clinical lipodystrophy. The FMR standard value is equal to 1.3 +/- 0.2. The FMR was higher in treated HIV-infected men with or without clinical lipodystrophy. The FMR was similar for naive HIV-infected men and controls. It was positively correlated with age, cumulative time on treatment, zidovudine, stavudine, or indinavir. BMD and fat mass were lower for treated and naYve HIV-infected men than for HIV-negative men. The FMR seems to be a valuable index for measuring fat mass distribution. We defined FMR standard values from the largest group of HIV-negative men to our knowledge. Applying FMR to HIV patients could help physicians to diagnose lipodystrophy earlier.

Background Osteopenia and adipose tissue maldistribution are two complications of highly active anti-retroviral therapy (HAART: 1 protease inhibitor + 2 nucleoside reverse transcriptase inhibitors). Dual energy x-rays absorptiometry (DEXA) is a reliable tool to assess total body and regional bone mineral and soft-tissue composition. Objectives (1) To compare the results of DEXA in HIV-infected patients treated or not with HAART, with or without clinical lipodystrophy and (2) to evaluate DEXA as a tool for early diagnosis of body fat redistribution. Methods A cross-sectional analysis was performed on 220 men. All subjects gave written informed consent. Controls (C): 106 healthy uninfected volunteers without medical or surgical history, nor immobilisation and therapies which may modify bone mineral density, mean age 38 years. One hundred and fourteen HIV-infected patients at steady-state, without opportunist disease, nor prophylactic drugs? use were divided in 3 groups: (i) 20 naive HIV-patients (N: mean age 38 years, disease duration 43 mths, viral load 3.7 log, CD4+ 417/mm3), (ii) 32 HIV-treated patients with no clinical lipodystrophy (n-CLD: mean age 35, disease duration 72 mths, HAART duration 15 mths, viral load 2.3 log, CD4+ 524/mm3), and (iii) 62 HIV-treated patients with clinical lipodystrophy (CLD: mean age 42, disease duration 94 mths, HAART duration 26 mths, viral load 1.8 log, CD4+ 483/mm3). Total body and regional soft-tissue composition were measured with DEXA (DPX-L, Lunar Corp. Acquisition and analysis software 4.6). The following parameters were studied: Fat Mass% (FM,%), Lean Mass (LM, kg), Bone Mineral Content (BMC, mg), and Fat Mass Index (FMI: trunk fat mass/legs fat mass). Statistics. Mean ± SD, ANOVA, Scheffe’s F procedure for post-hoc comparison. Results Lean Mass was the same in the 4 groups. Despite 43 months of disease duration, Naive and Controls had the same fat mass, BMC and FMI. The two treated HIV-infected groups had lower Fat Mass and upper Fat Mass Index than Controls. Loss in Fat Mass at the expense of the legs was proportional to duration of HAART. The great variability of the FMI (SD) in these two groups suggested a poor clinical sensitivity to change. Decrease of BMC seemed treatment-dependent. Lipodystrophy appeared also age-related. Conclusion DEXA allows an early diagnosis of fat maldistribution. We propose to perform this exam to all HIV-infected patients once a year before treatment and every 6 months in patients under treatment.