Density of ectopic fat depots predict distinct biomarkers of glycemic and insulinemic status in persons with HIV

PMCID: PMC12177074

PMID: 40533477

DOI: 10.1038/s41387-025-00381-y

Journal: Nutrition & diabetes

Publication Date: 2025-6-18

Authors: Park S, Widmer A, Swartz AZ, Koethe JR, Silver HJ

Key Points

• PWH with diabetes showed significantly altered tissue densities, with 2.5-fold higher hepatic steatosis prevalence compared to those without diabetes
• Myosteatosis was sevenfold higher in participants with diabetes, potentially predicting future sarcopenia and mortality risk
• CT morphometrics may offer a novel, early screening approach for metabolic dysfunction in people living with HIV

Summary

This groundbreaking study investigated the relationship between tissue density and metabolic dysfunction in people with HIV (PWH), utilizing CT imaging to examine how ectopic lipid accumulation correlates with glycemic status. Among 217 PWH, 29.0% had prediabetes and 30.4% had type 2 diabetes mellitus (T2DM), revealing significant differences in tissue morphometrics across glycemic groups.

The research demonstrated that PWH with diabetes exhibited unique tissue density characteristics, including higher subcutaneous adipose tissue (SAT) density, lower liver, pancreas, and skeletal muscle densities. Notably, these morphometric changes were robustly associated with glycemic and insulinemic biomarkers, suggesting that CT imaging could potentially provide earlier detection of metabolic perturbations than traditional clinical markers. The findings highlight the complex metabolic dysregulation in PWH, where fat deposition and tissue composition may differ from non-HIV populations.