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Decreased Limb Muscle and Increased Central Adiposity Are Associated with 5-Year All-cause Mortality in HIV Infection
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Reported by Jules Levin
CROI 2011 March 2 Boston
"Unintentional loss of weight and muscle due to aging and disease has been associated with increased mortality- Earlier work in 1982 found bedside estimates of arm muscle could be used in malnourished patients to predict the trajectory of muscle mass changes compatible with survival. More recent work in elderly nonHIV (2007) found decreased mid-arm muscle circumference and increased waist circumference are independently associated with mortality in older men. Landi in 2010 found dereased mid-arm muscle circumference is associated with mortality in older men"
"we found that lower arm skeletal muscle, lower leg skeletal muscle, and higher visceral were each independently associated with increased mortality. Those in the lowest tertile of arm or leg skeletal muscle had higher odds of death (arm: OR 2.0, 95%CI 0.96 to 4.0; leg: OR 2.4, 95%CI 1.2 to 4.8) than those in the highest respective tertiles. Those in the highest tertile of higher visceral had 2.1 to fold higher odds of death (95%CI 1.1 to 4.0) than those in the lowest tertile....Lipoatrophy does not appear to be associated with increased death risk....Decreased arm muscle alone accounted for 15% of the populatio-level mortality in HIV+ individuals....A substantial proportion of this mortality risk may be unrecognized because of the current reliance on BMI to assess wasting in clinical practice, which misses the combination of low muscle & higher VAT.....clinicians should consider measuring waist circumference & mid-arm muscle circumference & should be aware that patients with excess central fat may not necessarily have a low BMI to alert them to their true level of risk"
"In addition, mortality is increased in HIV+ even after accounting for CVD risk factors. it has been found that inflammation and renal disease are independently associated with mortality in HIV, both HIV infection and aging are associated with decreased skeletal muscle mass....aging is also associated with increases in subcutaneous fat and visceral adipose tissue"
Link to presentation:
http://app2.capitalreach.com/esp1204/servlet/tc?c=10164&cn=retro&s=20445&&dp=player.jsp&e=13724&mediaType=podiumVideo
Rebecca Scherzer*1,2, S Heymsfield3, D Lee4, W Powderly5, P Tien1,2, P Bacchetti1, M Shlipak1,2, C Grunfeld1,2, and Study of Fat Redistribution and Metabolic Change in HIV Infection
1Univ of California, San Francisco, US; 2San Francisco VAMC, CA, US; 3Pennington Biomed Res Ctr, Baton Rouge, LA, US; 4Univ of California, San Diego, US; and 5Univ Coll Dublin Sch of Med & Med Sci, Ireland
ABSTRACT
Background: Unintentional loss of weight and muscle due to aging and disease has been associated with increased mortality. Wasting and weight loss occur in HIV infection even in the modern era of effective ART. Our objective was to determine whether muscle loss, subcutaneous lipoatrophy, and central lipo-hypertrophy would predict death in HIV-infected individuals, independently of demographic and cardiovascular disease (CVD) risk factors, inflammation, and renal disease.
Methods: We determined the association of MRI to measured regional and total skeletal muscle and adipose tissue with 5-year, all-cause mortality in 922 HIV-infected persons in the study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM).
Results: After 5 years of follow-up, HIV-infected participants with arm skeletal muscle in the lowest tertile had a mortality rate of 23%, compared with 11% and 8% of those in the middle and highest tertiles. After multivariable adjustment for demographics, cardiovascular risk factors, HIV-related factors, inflammatory markers, and renal disease, we found that lower arm skeletal muscle, lower leg skeletal muscle, and higher visceral were each independently associated with increased mortality. Those in the lowest tertile of arm or leg skeletal muscle had higher odds of death (arm: OR 2.0, 95%CI 0.96 to 4.0; leg: OR 2.4, 95%CI 1.2 to 4.8) than those in the highest respective tertiles. Those in the highest tertile of higher visceral had 2.1 to fold higher odds of death (95%CI 1.1 to 4.0) than those in the lowest tertile.
Conclusions: Lower muscle mass and central adiposity appear to be important risk factors for mortality in HIV-infected individuals. A substantial proportion of this risk may be unrecognized because of the current reliance on body mass index in clinical practice.
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