Human Immunodeficiency Virus Type 1-Related Lipoatrophy and Lipohypertrophy Are Associated with Serum Concentrations of Leptin

The relationship between the adipocyte-derived hormone leptin, insulin resistance, and fat redistribution in patients with human immunodeficiency virus (HIV) infection has not been established. We classified a cohort of HIV type 1 (HIV- 1)-infected patients with ≥6 months of antiretroviral exposure as having no lipodystrophy (51 patients [43% of the cohort]), lipoatrophy (23 patients [19% of the cohort]), mixed lipodystrophy (29 patients [24% of the cohort]), or lipohypertrophy (17 patients [14% of the cohort]), on the basis of physical examination, anthropometric measurements, and the findings of dual-emission x-ray absorptiometry and computed tomography. Measurements of insulin resistance were higher for patients with each category of lipodystrophy, compared with those observed for patients with no lipodystrophy (P<.001 ). Mean leptin levels (± standard deviation) were lowest in patients with lipoatrophy (1.76 ± 1.20 ng/mL), highest in patients with lipohypertrophy (9.10 ± 6.86 ng/mL), and significantly different from those in patients without lipodystrophy (3.14 ± 2.30 ng/mL; both P<.01). In this cohort of antiretroviral-experienced HIV-infected patients, a low serum level of leptin was independently associated with insulin resistance in patients with lipoatrophy, after controlling for total and regional body fat.