Measurement of Abdominal Fat Changes and Predictors of Excess Fat Gain in HIV-Infected Individuals Initiating Therapy.

摘要

HIV-infected individuals beginning antiretroviral treatment are faced with several metabolic complications including central fat accumulation and severe weight increases. As the HIV-infected population is at an elevated risk for cardiovascular disease, monitoring abdominal fat changes as well as understanding predictors of fat gain are especially important. This dissertation examines the validity of accessible measures of abdominal fat changes including waist circumference and self-reported changes, as well as risk factors of abdominal fat changes and severe weight gain after therapy initiation.;We demonstrate that the simpler, cost-effective waist circumference and self-reported measurements of abdominal changes are correlated with standard computed tomography (CT) and dual x-ray absorptiometry (DXA) measurements, and could be potentially used as monitoring tools for abdominal fat gain in resource-limited and clinical trial settings. Baseline disease severity, including higher viral load and lower CD4+ levels, is associated with both increased abdominal size as well as overall severe weight increases in HIV-infected individuals initiating therapy. In addition, treatment differences in waist circumference increases may vary by sex and race/ethnicity. Individuals of black non-Hispanic race/ethnicity are also at a higher odds of severe weight increases. Further research is needed to elucidate why certain race/ethnicities may be more prone to weight and fat increases.