Debroy P, et al. - As people living with HIV (PLWH) commonly exhibit adipose tissue (AT) alterations, researchers investigated how antiretroviral therapy (ART) initiation changes AT density and how these changes are associated with immuno-metabolic parameters. In a prospective randomized clinical trial of ART initiation, treatment-naïve PLWH were randomized to tenofovir-emtricitabine plus atazanavir-ritonavir, darunavir-ritonavir, or raltegravir and underwent L4-L5 abdominal CT scans for measures of subcutaneous (SAT) and visceral (VAT) AT area and density. Among participants (n = 228; median age: 36 years), 89% were male and 44% were white non-Hispanic; baseline HIV-1 RNA 4.6 log₁₀ copies/mL, and CD4⁺ T cell count 344 cells/mm³. A significant decrease in SAT and VAT HU was observed in all arms over 96 weeks. The outcomes suggest the correlation of lower SAT and VAT density with greater plasma measures of systemic inflammation, lipid disturbances and insulin resistance independent of AT area, following virologic suppression. This infers changes in AT density with ART may result in adverse health outcomes independent of AT quantity.