Lower serum adiponectin level is associated with lipodystrophy among HIV-infected men in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) study

Objectives: Adiponectin levels are inversely related to cardiovascular risk and are low in diabetics and obese persons. We examined the association between adiponectin concentration and HIV-associated lipodystrophy, which remains unclear. Methods: The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) was a prospective cohort study of HIV-infected adults conducted in four US cities. Lean body and fat masses were assessed using dual-energy X-ray absorptiometry scans. Using baseline data from 2004 to 2006, we defined lipodystrophy using a sex-specific fat mass ratio and performed cross-sectional analyses of associated risks using multivariable logistic regression. Results: Among 440 male participants (median age 42 years; 68% non-Hispanic white; 88% prescribed combination antiretroviral therapy; median CD4 lymphocyte count 468 cells/μL; 76% with viral load < 400 HIV-1 RNA copies/mL; 5% diabetic; median body mass index 25 kg/m²), median concentrations of leptin and adiponectin were 3.04 ng/L [interquartile range (IQR) 1.77–5.43 ng/L] and 8005 μg/mL (IQR 4950–11 935 μg/mL), respectively. The prevalence of lipodystrophy was 14%. Lipodystrophy was significantly associated with increasing age [prevalence ratio (PR) 1.50; 95% confidence interval (CI) 1.10–2.06, per 10 years], adiponectin < 8005 μg/mL (PR 5.02; 95% CI 2.53–9.95), ever stavudine use (PR 2.26; 95% CI 1.36–3.75), CD4 cell count > 500 cells/μL (PR 2.59; 95% CI 1.46–4.61), viral load < 400 copies/mL (PR 3.98; 95% CI 1.25–12.6), highly sensitive C-reactive protein < 1.61 mg/L (PR 1.91; 95% CI 1.11–3.28) and smoking (PR 0.42; 95% CI 0.22–0.78). Conclusions: Among men in this HIV-infected cohort, the prevalence of lipodystrophy was similar to previous estimates for persons living with HIV, and was associated with lower adiponectin levels, potentially indicating increased cardiovascular disease risk.