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Less Inflammation in Metabolically Healthy vs Unhealthy Men With HIV - Associations Between Systemic Inflammatory Perturbations and Metabolic Health Vary by HIV Serostatus and BMI
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"Among HIV-infected, normal weight men, metabolically healthy men demonstrated less systemic inflammation than metabolically unhealthy men."....[from Jules: in other words in HIV+ men with no metabolic syndrome: hypertension, wide waist, high triglycerides, low LDL, high glucose - inflammation was lower & visceral fat was lower - in other words HIV appears associated with inflammation after eliminating the affect of these metabolic conditions]
18th International Workshop on Comorbidities and Adverse Drug Reactions in HIV, September 12-13, 2016, New York
Mark Mascolini
HIV-positive metabolically healthy men with normal weight had less systemic inflammation than metabolically unhealthy normal-weight men with HIV in a large Multicenter AIDS Cohort Study (MACS) analysis [1]. That difference did not apply to normal-weight men without HIV or to obese men with or without HIV.
MACS investigators defined metabolic health as meeting none or 1 of the 5 NCEP/ATP III criteria for metabolic syndrome: hypertension, wide waist, high triglycerides, low high-density lipoprotein cholesterol, and high glucose [2]. The researchers observed that some obese people remain metabolically healthy by this definition. Prior work by this team determined that (1) metabolic health does not vary by HIV status in obese men, and (2) in nonobese men HIV infection is associated with a lower prevalence of metabolic health. The new study analyzed links between HIV status, metabolic health, and markers of inflammation in MACS men with and without HIV.
The analysis involved 470 men with HIV and 368 HIV-negative men enrolled in the MACS Cardiovascular Disease 2 substudy. That substudy includes men 40 to 70 years old who weigh less than 300 pounds and never had coronary artery bypass grafting, heart valve surgery, or coronary angioplasty. This cross-sectional analysis compared inflammatory marker levels by body mass index (BMI) category and HIV status.
Men with HIV were significantly younger than HIV-negative men (median 54 versus 59, P < 0.001) and included a higher proportion of nonwhites (43% versus 29%, P < 0.001) and a higher proportion of current smokers (26% versus 19%, P < 0.001). Men with HIV had a lower BMI than men without HIV (median 25 versus 27 kg/m2, P < 0.001), but prevalence of metabolic syndrome was similar in the HIV and non-HIV groups (33% versus 30%, P = 0.14). Men with HIV had a median most recent CD4 count of 655, and they had a viral load below 50 copies at 89% of their visits in the past 5 years.
Among normal-weight men (BMI below 25 kg/m2), metabolically healthy men were significantly younger than metabolically unhealthy men (median 53 versus 57, P = 0.02) and had significantly lower levels of IL-6 (P = 0.03), soluble tumor necrosis factor receptor I (sTNFR) (P < 0.001), sTNFRII (P = 0.001), abdominal visceral fat (P < 0.001), and HOMA-IR, a measure of insulin resistance (P < 0.001). Metabolically healthy men had significantly higher levels of adiponectin (P < 0.001) and thigh subcutaneous fat (P = 0.001). Adiponectin regulates glucose levels and fatty acid breakdown.
Among normal-weight metabolically healthy men, those with HIV had significantly lower adiponectin and significantly higher visceral adipose tissue and HOMA-IR than HIV-negative men. Among obese men, HIV-positive men did not differ from HIV-negative men in levels of any factor associated with metabolic health.
Poisson regression analysis of biomarker levels associated with metabolic health in normal-weight HIV-positive men adjusted for age, race, BMI, HCV, protease inhibitor use, thymidine analog use, and current CD4 count. This analysis linked metabolic health to lower levels of IL-6 (adjusted prevalence ratio [aPR] 0.88, P = 0.005), hsCRP (aPR 0.91, P = 0.001), sTNFRI (aPR 0.72, P < 0.001), sTNFRII (aPR 0.69, P < 0.001), leptin (aPR 0.91, P = 0.03), and HOMA-IR (aPR 0.55, P < 0.001) but higher levels of adiponectin (aPR 1.27, P < 0.001).
The MACS team concluded that normal-weight metabolically healthy men with HIV had less systemic inflammation than metabolically unhealthy men. By these same measures, levels of systemic inflammation did not differ by metabolic health in normal-weight HIV-negative men or in HIV-positive or negative obese men. The researchers hope to explore how these inflammation markers "contribute to or are affected by specific metabolic disturbances."
References
1. Lake JE, Li X, Palella FJ Jr, et al. Associations between systemic inflammatory perturbations and metabolic health vary by HIV serostatus and BMI. 18th International Workshop on Comorbidities and Adverse Drug Reactions in HIV, September 12-13, 2016, New York. Abstract O05.
2. PubMed Health. Metabolic syndrome. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024493/
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