| Objective Objective To evaluate the characteristics of change in the body composition of HIV-infected male patients by Dual X-ray absorptiometry (DXA) under different HAART regimens.Materials and methods Body composition was measured by DXA from77HIV-infected male patients who were on trentment-naive subjects, aged20-71years, mean age38.2±11.1years, from Mar.,2009to Dec.,2013.The patients were divided into3groups (d4T arm, AZT arm and TDF arm) according to whether they were contained d4T, AZT, or TDF. Lamivudine(3TC) and either nevirapine(NVP) or efavirenz(EFZ) were the other two drugs, which were contained in the antiretroviral regimens equally. The patients enrolled in HAART regimens, who were taking the DXA scan on the treatment of baseline,1year and2years. Data of laboratory tests, body composition, bone mineral density of the right hip and lumbar spine were collected.Results HIV-infected male patients in d4T arm have the highest prevalence of lipodystrophy, and have the lowest prevalence of lipodystrophy in TDF arm. In the group of d4T arm, the prevalence of LD was twice as much as in AZT-containing regimes.There was a significant decrease in the Fat mass(FM) of total body and limbs after two years of HAART in the group of d4T and AZT arms(P<0.05), compared with baseline. In the group of TDF arm (P>0.05), there was no significant increase in the FM of limbs, compared with baseline. There was a significant increase in the FM of limbs in the group of TDF arm(P<0.05), compared with d4T arm and AZT arm, after two years’ HAART. Multiple linear regression results showed that change of limbs FM had a negative correlation with BMI of baseline and had a positive correlation with viral load of baseline. In d4T and AZT arms, changes were generally small in lumbar bone mineral density (BMD)(P>0.05), compared with baseline. After2years HAART, there were significant decreases in the BMD of femoral neck and right hip (P<0.05); changes of spine and hip BMD decreases significantly in TDF arm (P<0.05), compared with baseline. There was a significant difference in median changes of spine BMD between AZT arm and TDF arm after2years HAART (P<0.05). Changes of femoral neck and right hip BMD were correlated negatively with the BMI in baseline(r=-0.251, P =0.028; r=-0.239, P=0.036, respectively).Conclusions Conclusions HIV/AIDS male patients in d4T arm have high prevalence of LD, and have a lower prevalence of LD in TDF arm. The prevalence of LD in d4T arm was twice as much as AZT-containing regimes. In the d4T and AZT, the FM of total body and limbs decreases significantly, compared with baseline; and the amount of decrease was increasing with HAART over time; there was small increase in the FM in TDF arm. The study showed that the effect of HAART varies by different anatomic sites, different decrease of BMD. Compared with baseline, there was significant decrease of lumber BMD in TDF arm after1year HAART. There was significant decrease of lumber BMD in TDF arm, compared with AZT arm after2years HAART. The most obvious changes of BMD appeared in the first year of HAART. In conclusion, changes of BMD and body composition over time in male patients with different regimens can be evaluated by DXA, which contributes to the adjustment of the treatment regimens and prevention of complications. Objective To evalute the changes of body composition in men patients with human immunodeficiency (HIV)-related lipodystrophy(LD) synodrome (HIV-LD) switching from stavudine(d4T) to zidovudine(AZT) or tenofovir(TDF) by Dual-Energy X-Ray Absorptiometry(DXA).Methods Total47men with HIV-LD who had been exposed to stavudine(d4T) befor the first of two DXA assessments. After diagnosed HIV-LD, they received two different treatment regimens, AZT group:switching from d4T to zidovudine (AZT), TDF group: switching from d4T to TDF, changes of body composition in two groups evaluated by Dual-Energy X-Ray Absorptiometry (DXA).Results Compared with baseline, lower limb lean mass showed a significant increase (t=2.781,95%CI0.02～0.10, P<0.01) and lower limb fat mass had a small decrease(P=0.05) in AZT group; In TDF group, There were significant increases in upper limb fat mass[(0.6±0.3)Kg、(1.0±0.7)Kg, t=2.422,95%CI0.04±0.74, P<0.05]and lower limb fat mass[(1.8±0.8)Kg、(2.6±1.7)Kg, t=2.369,95%CI0.08±1.66, P<0.05]. In AZT group, Changes from baseline were generally small in Lower limb fat mass,(median-0.04kg,-4.55%), In TDF group, increases above the baseline value in lower limb fat mass and percentage of lower limb fat gain were even greater(median0.463Kg,27.41%). In a visual comparison of DXA results between AZT and TDF recipients, more fat gain in the legs fat mass in patients who switched from d4T to TDF (U=2.954, P<0.01).Conclusions Compared with AZT group, Switching from d4T to TDF led to more increases in legs fat mass. Replacing d4T with TDF resulted in improvement in lipodystrophy. But LD did not worsened and lean mass increased in AZT group, which can be replaced d4T in clinical treatment. Changes in body composition over time in men patients with HIV-LD can be evaluated by DXA, which contributes to the adjustment of the treatment regimens. |
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