Interventions for visceral adiposity associated with human immunodeficiency virus: application of a method for assessing efficacy.

In addition to lipoatrophy of the subcutaneous fat compartment and lipohypertrophy of the breasts and dorsocervical fat pad, excess visceral fat is considered to be part of human immunodeficiency virus (HIV)-associated lipodystrophy. Because of associations between visceral adiposity and atherosclerotic risk and undesirable clinical and psychological effects, therapies for this morphological alteration are under investigation. The non-HIV literature on the visceral fat effects of various weight-reduction methods provides some insight into the difficulty that lies ahead. We demonstrate the application of a method published by Smith and Zachwieja to 3 studies of HIV that resulted in a significant loss of body fat. The method is meant to control for differences in the initial amount of visceral fat per subcutaneous fat and for absolute weight change. The results show that the body composition differences in HIV may require the development and application of a new method that permits wider variation in fat distribution.