Regional Adipose Tissue and Lipid and Lipoprotein Levels in HIV-Infected Women

BACKGROUND: HIV infection and antiretroviral therapy are associated with dyslipidemia, but the association between regional body fat and lipid levels is not well described. METHODS: Multivariable linear regression analyzed the association between magnetic resonance imaging-measured regional adipose tissue and fasting lipids in 284 HIV-infected and 129 control women. RESULTS: Among African Americans, HIV-infected women had higher triglyceride (116 vs. 83 mg/dL; P < 0.001), similar high-density lipoprotein (HDL; 52 vs. 50 mg/dL; P = 0.60), and lower low-density lipoprotein (LDL; 99 vs. 118 mg/dL; P = 0.008) levels than controls. Among whites, HIV-infected women had higher triglyceride (141 vs. 78 mg/dL; P < 0.001), lower HDL (46 vs. 57 mg/dL; P < 0.001), and slightly lower LDL (100 vs. 107 mg/dL; P = 0.059) levels than controls. After adjustment for demographic and lifestyle factors, the highest tertile of visceral adipose tissue (VAT) was associated with higher triglyceride (+85%, 95% confidence interval [CI]: 55 to 121) and lower HDL (-9%, 95% CI: -18 to 0) levels in HIV-infected women; the highest tertile of leg subcutaneous adipose tissue (SAT) was associated with lower triglyceride levels in HIV-infected women (-28%, 95% CI: -41 to -11) and controls (-39%, 95% CI: -5 to -18). After further adjustment for adipose tissue, HIV infection remained associated with higher triglyceride (+40%, 95% CI: 21 to 63) and lower LDL (-17%, 95% CI: -26 to -8) levels, whereas HIV infection remained associated with lower HDL levels (-21%, 95% CI: -29 to -12) in whites but not in African Americans (+8%, 95% CI: -2 to 19). CONCLUSIONS: HIV-infected white women are more likely to have proatherogenic lipid profiles than HIV-infected African American women. Less leg SAT and more VAT are important factors associated with adverse lipid levels. HIV-infected women may be at particular risk for dyslipidemia because of the risk for HIV-associated lipoatrophy.