Hyperandrogenemia in human immunodeficiency virus-infected women with the lipodystrophy syndrome

A novel lipodystrophy syndrome characterized by insulin resistance, hypertr iglyceridemia, and fat redistribution has recently been described in human immunodeficiency virus (HIV)-infected men and women. Women with the HIV lip odystrophy syndrome exhibit a marked increase in waist-to-hip ratio and tru ncal adiposity; however, it is unknown whether androgen levels are increase d in these patients. In this study, we assessed androgen levels in female p atients with clinical lipodystrophy based on evidence of significant fat re distribution in the trunk, extremities, neck and/or face (LIPO: n = 9; age, 35.7 +/- 1.7 yr; BMI, 24.7 +/- 0.8 kg/m(2)) in comparison with age- and BM I-matched nonlipodystrophic HIV-infected females (NONLIPO: n = 14; age, 37. 6 +/- 1.1 yr; BMI, 23.4 +/- 0.6 kg/m(2)) and healthy non-HIV-infected contr ol subjects (C: n = 16; age, 35.8 +/- 0.9 yr; BMI, 23.1 +/- 0.4 kg/m(2)). F asting insulin, lipid levels, virologic parameters, and regional body compo sition using dual energy x-ray absorptiometry were also assessed. Total tes tosterone [ LIFO, 33 +/- 6 ng/dL(1.1 +/- 0.2 nmol/L); NONLIPO, 17 +/- 2 ng/ dL (0.6 +/- 0.1 nmol/L); C,23 +/- 2 ng/dL(0.8 +/- 0.1 nmol/L); P < 0.05 LIP O us. C and LIPO vs. NONLIPO] and free testosterone determined by equilibri um dialysis [LIPO, 4.5 +/- 0.9 pg/mL (16 +/- 3 pmol/L); NONLIPO, 1.7 +/- 0. 2 pg/mL (6 +/- 1 pmol/L); C, 2.4 +/- 0.2 pg/mL (8 +/- 1 pmol/L); P < 0.05 L IPO us. C and LIPO vs. NONLIPO] were increased in the lipodystrophic patien ts. Sex hormone-binding globulin levels were not significantly different be tween LIPO and C, but were significantly lower in the LIPO vs. NONLIPO pati ents (LIPO 84 +/- 7 vs. NONLIPO 149 +/- 17 nmol/L, P < 0.05). The LH/FSH ra tio was significantly increased in the LIPO group compared with the NONLIPO and C subjects (LIPO, 2.0 +/- 0.6; NONLIPO, 1.1 +/- 0.1; C, 0.8 +/- 0.1; P < 0.05 LIPO us. NONLIPO and LIPO vs. C). Body fat distribution was signifi cantly different between LIPO and C subjects. Trunk to extremity fat ratio (1.46 +/- 0.17 vs. 0.75 +/- 0.05, LIPO vs. C, P < 0.05) was increased and e xtremity to total fat ratio decreased (0.40 +/- 0.03 vs. 0.55 +/- 0.01, LIP O vs. C, P < 0.05). In contrast, fat distribution was not different in the NONLIPO group us. control subjects. Among the HIV-infected patients, free t estosterone correlated with percent truncal fat (trunk fat/trunk mass) (r = 0.43, P = 0.04). These data suggest that hyperandrogenemia is another pote ntially important feature of the HIV-lipodystrophy syndrome in women. Addit ional studies are necessary to determine the clinical significance of incre ased androgen levels and the relationship of hyperandrogenism to fat redist ribution and insulin resistance in this population of patients.