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Fat and Lean Mass Changes Similar With and Without HIV in Ireland Cohort
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25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston
from Jules: This UPBEAT study did NOT look at central belly fat - but there was this presentation by Grace McComsey at CROI 2015 who did different measures than in UPBEAT which did look at belly central fat finding increases, and looked at proportion of patients with 10% or greater & 20% or greater limb fat loss in HIV+ and found 16% to 18% had 10% or greater limb fat loss & 6% to 8% had 20% or greater limb fat loss, regardless of which of the 3 regimens they studied subjects were taking - ATV/r, RAL, DRV/r. McComsey also found overall increases in limb fat like UPBEAT did. But she found increases in central belly fat which UPBEAT did not measure nor did UPBEAT look at percent of subjects who had limb fat loss as McComsey did. McComsey patients had lower BMI at baseline & were treatment naive at baseline then went on 1 of 3 regimens, and McComsey found increases in BMI as did UPBEAT. - Body Composition Changes after Initiation of Raltegravir or Protease Inhibitors..... - (03/16/15)
Mark Mascolini
Arm fat and arm lean mass increased over 3 years in both HIV-positive and negative members of HIV UPBEAT, a prospective cohort study in Ireland [1]. People with and without HIV did not differ in any fat or lean mass measure in this 462-person analysis.
Body composition changes in people with HIV draw much research attention, HIV UPBEAT researchers noted. But one aspect of body composition remains poorly understood: how people taking a stable antiretroviral regimen differ over time from demographically similar people without HIV. Because well-founded concerns about adiposity and sarcopenia (muscle loss) persist in people with HIV, these investigators conducted a 3-year analysis of fat and lean mass changes in their cohort.
HIV UPBEAT enrolls HIV-positive and negative people with similar demographics and monitors them periodically [2]. This analysis used annual DXA scans to measure total and regional (arm, leg, and truck) fat and lean mass. The investigators used longitudinal mixed-effects models to determine absolute change in log-transformed body composition measures.
At three annual visits from February 2011 to June 2014, contingents of 462, 367, and 262 cohort members had DXA scans. At the first visit, 199 people with HIV were younger than 263 HIV-negative people (median 38.6 versus 41.7, P = 0.06) and included more men (59.3% versus 13.4%, P = 0.001) and more Africans (39.2% versus 24.7%, P = 0.001).
Over the 3 annual study visits, arm fat rose 4.95% yearly in the two study groups (P < 0.0001) with no significant difference between groups. Arm lean mass also rose significantly in the two groups by 1.62% yearly (P < 0.0001), again with no difference between groups. None of the other body composition parameters changed significantly with time: leg fat, trunk fat, total fat, leg lean mass, trunk lean mass, or total lean mass. And annual percent change in these measures never differed significantly between people with and without HIV. Findings did not change when researchers adjusted the analyses for age, gender, or ethnicity.
The researchers warned that their analysis may be limited by (1) possible selection bias reflected in participant attrition over the years, (2) absence of relevant outcome measures like frailty, and (3) limited power to detect smaller changes in body composition.
With those caveats in mind, the HIV UPBEAT team proposed that their findings in this relatively young cohort are reassuring: "alterations in body composition in these people living with HIV reflect those observed in a relative HIV-negative population."
References
1. Cotter AG, Macken A, Tinago W, et al. Change in fat/lean mass in HIV-positive and -negative subjects; data from HIV UPBEAT. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 733.
2. Cotter AG, Sabin CA, Simelane S, et al; HIV UPBEAT Study Group. Relative contribution of HIV infection, demographics and body mass index to bone mineral density. AIDS. 2014;28:2051-2060.
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