Gender

Many studies have found that the likelihood and severity of fat accumulation is higher in women, whereas the likelihood and severity of fat depletion is higher in men. Men also seem more likely to experience metabolic abnormalities. The reasons for these gender differences are not understood.

For example, the Self-Ascertained Lipodystrophy Syndrome Assessment (SALSA) study found that 97% of women and 84% of men reported fat accumulation. In contrast, 77% of men and 61% of women reported fat loss of the face, limbs and/or buttocks. Men were significantly more likely than women to develop high lipid levels. Only 32% of the women in this study had high triglycerides and high cholesterol. 1 2 3

A prevalence study conducted in the US has also found that women were more likely to experience fat accumulation than fat loss (63% and 11%) compared with men (36% and 19%). However, race was a more powerful risk factor than gender; African American men and women were less likely to experience fat accumulation. 4

An Italian study of 704 individuals followed for an average of 96 weeks after starting antiretroviral therapy found no association between gender and fat accumulation by itself, but women were significantly more likely to experience a mixed syndrome of fat accumulation and peripheral fat wasting than men. 5

Women in the ICONA cohort were significantly more likely to develop fat accumulation or a mixed syndrome of fat gain and fat loss. 6

In a much larger study of 2258 individuals (29.8% women) by the same investigator, women were found to be significantly more likely to develop body fat changes, while men were significantly more likely to develop lipoatrophy, despite no significant difference in d4T exposure between the two groups. 7

Men and women also appear to have different risk factors associated with body fat changes. A review of 526 patients with lipodystrophy in New York and Montreal found that whilst fat accumulation in men was associated with higher body mass index and viral load below 500 copies/ml, these factors were not associated with fat accumulation in women. In men, fat wasting was significantly associated with d4T treatment, whereas this association was not evident in women. Instead, fat wasting was significantly associated with a body mass index below 28.5, an association that was not evident in men. 1 2

This body of evidence strongly suggests that women are more prone to fat accumulation, whilst men are more likely to experience fat wasting. However, the findings of several recent studies have been at odds with this conclusion. In the Women’s Interagency HIV Study (WIHS), DEXA analysis found that HIV-positive women receiving antiretroviral treatment had significantly lower levels of leg fat than either untreated HIV-positive women or HIV-negative women. However, truncal fat was also lower in HIV-positive women than in HIV-negative women. 8

The US FRAM study (Fat Redistribution and Metabolic Change in HIV Infection) investigated 350 HIV-positive women and 142 matched HIV-negative controls. As with the FRAM findings for men, no association was found between peripheral lipoatrophy and truncal fat accumulation in women. However, the study also found that significantly more HIV-positive women reported peripheral lipoatrophy than HIV-negative controls (28% vs 4%); that central fat accumulation was comparable in both groups (62% vs 63%); and peripheral fat accumulation was less common in HIV-positive women (35% vs 62%). These findings are in accord with the WIHS findings but appear to contradict many others. The researchers found that HIV-positive women without lipoatrophy had more trunk fat than HIV-negative controls, whereas this was not the case for men. 9

References

  1. Muurahainen N et al. Gender differences in HIV-associated adipose redistribution syndrome (HARS): an update. Seventh Conference on Retroviruses and Opportunistic Infections, San Francisco, abstract 26, 2000a
  2. Muurahainen N et al. Different factors are associated with abnormal fat accumulation and fat depletion in men and women with HIV. Antiviral Therapy 5 (Supp 5): 65, 2000b
  3. Falutz J et al. Gender related differences in the lipodystrophy syndrome. Third International Conference on Nutrition and HIV Infection, Cannes, abstract O-4, 1999
  4. Wanke C et al. Prevalence of fat deposition and fat atrophy in a cohort of HIV-infected men and women. Seventh Conference on Retroviruses and Opportunistic Infections, San Francisco, abstract 24, 2000
  5. Galli M et al. Risk of developing adipose tissue alterations after starting antiretroviral therapy in naive patients. Antivir Ther 5: S59, 2000
  6. Galli M et al. Body habitus changes and metabolic alterations in protease inhibitor-naïve HIV-1 infected patients treated with two nucleoside reverse transcriptase inhibitors. J Acquir Immune Defic Syndr 29: 21-31, 2002
  7. Galli M et al. Gender differences in antiretroviral drug-related adipose tissue alterations. J Acquir Immune Defic Syndr 34: 58-61, 2003
  8. Mulligan K et al. Fat distribution in HIV-infected women in the United States: DEXA substudy in the Womens Interagency HIV Study. J Acquir Immune Defic Syndr 38: 18 22, 2004
  9. FRAM (Study of Fat Redistribution and Metabolic Change in HIV Infection). Fat distribution in women with HIV infection. J Acquir Immune Defic Syndr 42(5):562-571, 2006
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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