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Wider Waists and Hips: Sorting Effects of Age, HIV, and Antiretrovirals
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Mark Mascolini
XVI International AIDS Conference, Toronto
August 16, 2006
Waists get wider and hips get heftier as men with HIV get older, but the same thing happens to men without HIV in the US Multicenter AIDS Cohort Study (MACS).
This 1053-person analysis found that cumulative nonnucleoside (NNRTI) or protease inhibitor (PI) therapy had no impact on waist, hip, arm, or thigh width. But as years of nucleoside (NRTI) therapy piled up, waists, hips, and thighs (but not arms) got skinnier.
Those changes--or lack of change--held true in a study of 661 gay men with HIV and 392 HIV-uninfected gays in the same cohort. Body mass index also rose with age regardless of HIV status.
MACS signs up gay men who run a risk of HIV and monitors them over the years whether or not they become infected. In 1999 MACS researchers got out tape measures and started tracking waist and limb changes in cohort members.
When MACS members had their first body measures, men without HIV were significantly older than the HIV-infected group (48.3 versus 45.7 years) and had a significantly greater body mass index (27.3 versus 25.3 kg/m2) and waist width (96.4 versus 90.2 cm). Hips, thighs, and arms were also significantly bigger when first measured in the uninfected group than in the infected group (P < 0.001 for all preceding differences).
Among men taking antiretroviral therapy from 1999 through 2004, body mass index fell with every year of NRTI therapy (slope -0.113, P = 0.001) and rose with every year of NNRTI treatment (slope +0.123, P = 0.087) but changed hardly at all with accumulating years of PI therapy (slope +0.030, P = 0.464). (MACS statisticians sorted out these drug class-specific effects over time in a mixed-effects regression model.)
Waist and hip width rose with each year of follow-up in both the HIV and non-HIV groups, though people without HIV had bigger yearly gains:
- Yearly waist change (cm): +0.5 without HIV, P < 0.001; +0.33 with HIV, P = 0.022
- Yearly hip change (cm): +0.3 without HIV, P < 0.001; +0.11 with HIV (not significant)
But after statistical adjustment for antiretroviral effects and first body measures, waist girth grew faster in the HIV group than in the non-HIV group. This universally if ruefully acknowledged pants-size surge, the MACS team proposed, represents a "return to health" with ongoing antiretroviral therapy.
The MACS investigators believe the gains in body mass index and waist and hip width in all men studied reflect the long-recognized effects of aging.
A separate MACS analysis compared body composition in 39 HIV-infected men who believed they had lipodystrophy with two control groups--23 men with HIV but without lipodystrophy and 32 HIV-uninfected cohort members [2].
Measuring fat with CT or DEXA scans, the MACS team found that the men with self-reported lipodystrophy had significantly more visceral adipose tissue (VAT) than the HIV-infected men without lipodystrophy (P = 0.02). But VAT did not differ between the lipodystrophy group and the uninfected group. Subcutaneous abdominal tissue was significantly lower in both HIV groups than in the non-HIV group (P < 0.01).
Compared with both control groups, the men with self-reported lipodystrophy had lower body mass index, extremity fat, and hip and thigh circumference. Waist-to-hip ratio was significantly higher in the men with lipodystrophy (0.977) than in the HIV-infected control group (0.948) or the non-HIV control group (0.946) (P = 0.0452).
References
1. Brown TT, Wang Z, Chu H, et al. Longitudinal increases in waist circumference are associated with HIV serostatus, independent of antiretroviral therapy. XVI International AIDS Conference. August 13-18. Toronto. Abstract WEPE0136.
2. Dobs A, Brown T, John M, et al. Body composition in men with lipodystrophy enrolled in the multicenter AIDS cohort study. XVI International AIDS Conference. August 13-18. Toronto. Abstract MOPE0293.
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