Changes in abdominal fat following antiretroviral therapy initiation in HIV-infected individuals correlate with waist circumference and self-reported changes

Background: We examined whether waist circumference (WC) and self-reported abdominal size changes can estimate visceral adipose tissue (VAT) changes for those initiating antiretroviral therapy (ART). Methods: Prospectively collected data from ACTG A5257 and its metabolic substudy, A5260s, were used for this analysis. ART-naive HIV-infected participants were randomized to one of three contemporary ART regimens. Changes in abdominal CT-measured VAT and total adipose tissue (TAT) and DXA-measured trunk fat were tested for association with WC changes (by Pearson correlation) and categories of self-reported abdominal size changes (by ANOVA) between entry and week 96. Linear models compared WC and self-reported changes. Results: The study population (n=328) was predominantly male (90%) and White non-Hispanic (44%) with a baseline median age of 36 years and body mass index of 25 kg/m². At week 96, median WC change was +2.8 cm. Of those reporting at week 96, 53% indicated ‘no change/lost’, 39% ‘gained some/somewhat larger’ and 8% ‘gained a lot/much larger’ as their self-reported changes. Trunk fat, VAT and TAT changes differed across self-reported groups (ANOVA P<0.0001 for all), and the group ordering was as expected. WC changes were strongly correlated with CT and DXA changes (trunk fat: r=0.72, p<0.0001; VAT: r=0.52, p<0.0001; TAT: r=0.62, p<0.0001). While WC changes explained a greater proportion of VAT, TAT and trunk fat variation, self-reported changes remained a significant predictor after controlling for WC (p<0.05). Conclusions: WC and self-reported abdominal changes each correlated directly with imaging-derived abdominal fat measures, and can be used as reliable, affordable tools for central adiposity assessment.