Body Composition Changes In HIV/AIDS Patients Receiving Long-term Highly Active Antiretroviral Therapy

[Objective]:To evaluate the effect of highly active antiretroviral therapy (HAART) on body composition in HIV/AIDS patients and correlating clinical factors. To evaluate the incidence of lipodystrophy (LD) and osteopenia/osteoporosis after HAART.[Methods]:1) A crosssectional study.144HIV patients were divided into3groups:untreated group with51patients, HAART for1-2years group with47patients, HAART over5years group with46patients;20healthy individuals included as a control group. Clinical lipodystrophy were defined as concordance between patient's report of change and physical examination. Body composition was measured by dual-energy x-ray absorptiometry (DXA). Body composition include fat mass (FM) and lean mass (LM) and bone mineral content (BMC) and bone mineral density (BMD) and BMD-T score and BMD-Z score.2) A2-year, longitudinal study. All of the53patients fulfilled1year's follow-up and34patients completed2years' follow-up. Body composition was measured by DXA at baseline and were repeated measured after1year and2years of HAART. The inceidence of lipodystrophy and osteopenia/osteoporosis were measured after HAART.[Rseults]:1) HIV/AIDS patients with NRTIs therapy have high prevalence of lipodystrophy. The incidences of LD were26.4%after1year HAART and44.1%after2years HAART and58.7%for HAART over5years group. The incidence of LD mainly occurred in the first2years of HAART. DXA measurements:FM of total body and limbs were significantly lower after HAART. FM of total body and limbs negative correlated with HAART duration. Trunk FM was not significantly changed after HAART.2) The incidence of LD was32.3%when taking d4T-containing regimens and18.2%in AZT-containing regimens after1year HAART. The incidence of LD was66.7%when taking d4T-containing regimens and26.3%in AZT-containing regimens after2years HAART. The prevalence of LD was2.5times higher when taking d4T compared with AZT-containing regimes (P=0.036). The crosssectional study also showed that the prevalence of LD was2.1times higher when taking d4T compared with AZT-containing regimens (68.0%vs.32.6%, P=0.001). 3) DXA measurements:Incidence of loss of limbs FM30-50%after2years HAART were significantly higher than1year follow up (P<0.05). The incidence of loss of limbs FM>50%also increased after2years therapy than1year follow up. When taking FM loss>20%and>30%and>50%as standard, the sensitivity of clinical evaluation were28.9%and42.9%and66.7%respectively. Compared with clinical evaluation, DXA is an objective tool for earlier measure HAART-related lipoatrophy.4) The LM of lower limb and trunk and tody body were increased after1year and2years HAART. Trunk LM were increased in HAART for1-2yers group than untreated group; There was not significantly increased in HAART over5years group than HAART for1-2years group. LM increased in the first2years HAART and remained stable with long-term HAART.5) BMD-Z score of right hip and right femoral neck were significantly decreased after1year and2year follow up; the change of right femoral neck were[M(IQR)]-2.66(-5.32--0.12)%. BMD-Z score of right femoral neck was significantly lower in HAART over5years group than untreated group. BMD reduce mainly occurred in the first year of HAART and reduced slowly with long-term HAART.6) Longitudinal study shows that the incidence of osteopenia rose from17.0%to28.3%after1year HAART. The crosssectional study shows that the incidence of osteopenia in HAART for1-2years group and HAART over5years group were higher than untreated group, but there were no significantly difference(P=0.276). Body weight was revealed as a risk factor of osteopenia/osteoporosis.7) BMD were significantly lower in d4T-containing regimens than AZT-containing regimens in crosssectional study. There was not significantly relevance in BMD change and HAART regimens (include d4T-containing regimens and AZT-containing regimens) in longitudinal study.[Conclusion]:HIV/AIDS patients with NRTIs therapy have high prevalence of LD. The incidence of LD mainly occurred in the first2years of HAART. The incidence of LD was significantly higher when taking d4T-containing regimens than AZT-containing regimens. The results support that we can choose d4T-containing HAART regimens in the first half year, after half a year we can use AZT replace d4T for long-term treatment; This scheme can ensure the curative effect and not increase costs and significantly reduce the incidences of LD. FM of total body and limbs were significantly lower after HAART. FM of total body and limbs negative correlated with HAART duration. Trunk FM was not significantly changed after HAART. Compared with clinical evaluation, DXA is an objective tool for earlier measure HAART-related lipoatrophy. LM increased in the first2years HAART and remained stable with long-term HAART. BMD reduce mainly occurred in the first year of HAART and reduced slowly with long-term HAART. Right femoral neck reduced significantly. The incidence of osteopenia increased after HAART. DXA is an objective tool to evaluate FM and BMD change. Patients in long-term HAART combined with risk factors such as old age or lower body weight or d4T-containing regimens should be checked by DXA regularly.