Increased fat accumulation in the liver in HIV-infected patients with antiretroviral therapy-associated lipodystrophy

AIDS. 2002 Nov 8;16(16):2183-93. doi: 10.1097/00002030-200211080-00011.


Objective: To determine liver fat content in patients with highly active antiretroviral therapy (HAART)-associated lipodystrophy.

Background: Lipodystrophy in several animal models is associated with fat accumulation in insulin-sensitive tissues, such as the liver. This causes hyperinsulinaemia, dyslipidaemia and other features of insulin resistance.

Design: A cross-sectional study.

Subjects and methods: Three age- and weight-matched groups were compared: 25 HIV-positive men with HAART-associated lipodystrophy (HAART+LD+), nine HIV-positive men receiving HAART, but without lipodystrophy (HAART+LD-), and 35 HIV-negative healthy men (HIV-). Liver fat content was measured using proton spectroscopy. Intra-abdominal and subcutaneous fat were determined using magnetic resonance imaging.

Results: Liver fat content was significantly higher in the HAART+LD+ (8 +/- 10%) than the HIV- (5 +/- 7%; P < 0.05) or the HAART+LD- (3 +/- 5%; P < 0.01) group. Liver fat content correlated with serum fasting insulin in the HAART+LD+ (r = 0.47; P < 0.05) and HIV- groups (r = 0.65; < 0.001), but not with the amount of intra-abdominal fat. Within the HAART+LD+ group, serum insulin did not correlate with the amount of intra-abdominal fat. The HAART+LD+ group had a lower serum leptin concentration when compared to the two other groups. Features of insulin resistance, including hepatic fat accumulation, were not found in HAART+LD-group.

Conclusions: The severity of the insulin resistance syndrome in patients with HAART-associated lipodystrophy is related to the extent of fat accumulation in the liver rather than in the intra-abdominal region. Fat accumulation in the liver may therefore play a causative role in the development of insulin resistance in these patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue / metabolism*
  • Adult
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • Cross-Sectional Studies
  • HIV Infections / drug therapy*
  • HIV-Associated Lipodystrophy Syndrome / etiology
  • HIV-Associated Lipodystrophy Syndrome / metabolism*
  • Humans
  • Liver / metabolism*
  • Male
  • Protons
  • Spectrum Analysis


  • Protons