in this large contemporary HIV cohort, the prevalence of subclinical functional and structural cardiac abnormalities was greater than expected for age. Abnormalities were mostly associated with expected and often modifiable risks. Lifestyle modification should become a greater priority in the management of chronic HIV disease.

Suppressing HIV replication below clinical thresholds was associated with less progression of atherosclerosis. The proatherogenic mechanisms of HIV replication and the net CVD benefit of different antiretroviral drugs should be a focus of future research.

The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF-containing HAART compared with those who took TDF-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia.

Objectives Adiponectin levels are inversely related to cardiovascular risk and are low in diabetics and obese persons. We examined the association between adiponectin concentration and HIV‐associated lipodystrophy, which remains unclear. Methods The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) was a prospective cohort study of HIV‐infected adults conducted in four US cities. Lean body and fat masses were assessed using dual‐energy X‐ray absorptiometry scans. Using baseline data from 2004 to 2006, we defined lipodystrophy using a sex‐specific fat mass ratio and performed cross‐sectional analyses of associated risks using multivariable logistic regression. Results Among 440 male participants (median age 42 years; 68% non‐Hispanic white; 88% prescribed combination antiretroviral therapy; median CD4 lymphocyte count 468 cells/μL; 76% with viral load < 400 HIV‐1 RNA copies/mL; 5% diabetic; median body mass index 25 kg/m2), median concentrations of leptin and adiponectin were 3.04 ng/L [interquartile range (IQR) 1.77–5.43 ng/L] and 8005 μg/mL (IQR 4950–11 935 μg/mL), respectively. The prevalence of lipodystrophy was 14%. Lipodystrophy was significantly associated with increasing age [prevalence ratio (PR) 1.50; 95% confidence interval (CI) 1.10–2.06, per 10 years], adiponectin < 8005 μg/mL (PR 5.02; 95% CI 2.53–9.95), ever stavudine use (PR 2.26; 95% CI 1.36–3.75), CD4 cell count > 500 cells/μL (PR 2.59; 95% CI 1.46–4.61), viral load < 400 copies/mL (PR 3.98; 95% CI 1.25–12.6), highly sensitive C‐reactive protein < 1.61 mg/L (PR 1.91; 95% CI 1.11–3.28) and smoking (PR 0.42; 95% CI 0.22–0.78). Conclusions Among men in this HIV‐infected cohort, the prevalence of lipodystrophy was similar to previous estimates for persons living with HIV, and was associated with lower adiponectin levels, potentially indicating increased cardiovascular disease risk.