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Fat/Weight Gain/Aging Faster-mitochondria/Fat Tissue/Genetics/Metabolic Rate-Calorie Intake
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FAT GAINS OCCUR AFTER ART WITHOUT CHANGES IN METABOLIC RATE OR CALORIC INTAKE - see poster below
CROI 2020
This CROI elevated discussions and new data to a new higher level than previously around aging, comorbidities, the impact & danger associated with the severe changes PLWH experience regarding fat & weight & its relationship to mortality & aging & specifically relates to the oral by Julia Marcus on lifespan in Kaiser, where she reported severe earlier onset of comorbidities for PLWH compared to uninfected,", in other words PLWH much much less comorbidity free yrs, meaning comorbidities occurred much earlier for HIV+ with little or no change in this since 2005 through now. You can see in this graph PLWH got chronic kidney disease at average age of 55 in 2005 compared to 76 in HIV-neg and in 2014-2016 average age for contracting CKD was 62 in HIV+ compared to 79 in HIV-neg - a big gap that has not improved much. This study also reports 9 years less life expectancy for HIV+ vs HIV- except for those who started ART with >500 CD4 where life expectancy was the same for HIV+ & HIV- in essence saying many older PLWH & those who started ART later with low nadir CD4s may be subject to these affects of severe metabolic & immune disturbances & deficiencies due to HIV. It does appear that these affects may be variable, with some PLWH experiencing them much worse than others. This is where the other factors discussed in the 2 sessions linked to below "Metabolics" & Fat Focus" may be relevant: genetics, diabetes, lifestyle (diet, exercise), legacy affects of substance abuse & injection drug use, HCV. Then there was a study on aging & epigenetic aging. Previously studies in epigenetic aging found HIV+ age more quickly "we find that both chronic and recent HIV infection lead to an average aging advancement of 4.9 years, increasing expected mortality risk by 19%. http://www.natap.org/2016/HIV/051216_02.htm", at this CROI they reported ART reduced age advancement in HIV from 8.3 to 6.5 Below is link to study reporting mitochondria damage which can be caused by inflammation, HIV and certain ARTs are associated with lower performance on the MoCA (reduced cognitive function) , greater exhaustion, and slower walk; this affect may be associated with starting ART late (<500 cd4), since HIV can cause mitochondrial damage delaying the start of ART may allow for more damage & aging related & comorbidities concerns. Jules Levin, NATAP
GREATER WEIGHT GAIN AFTER SWITCH TO INSTI-BASED REGIMEN FROM NNRTI VS. PI REGIMENS - (03/11/20)
IMPACT OF ANTIRETROVIRAL THERAPY INITIATION ON EPIGENETIC AGING AND TELOMERE LENGTH - (04/06/20)
Age advancement (EA minus chronological age) significantly improved after ART initiation (BL: 8.3 vs W96: 6.5 years, p=0.007). EA stabilized and EAA slowed in the majority of patients after starting ART. However, an age advancement of 6.5 years persisted after the first two years of successful ART.
Comorbidities at CROI - mortality, aging ..... - (04/20/20)
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CROI: Increased overall life expectancy but not
comorbidity-free years for people with HIV - Mark Mascolini - (03/11/20)
CROI: METABOLIC COMPLICATIONS OF HIV AND ITS THERAPIES (03/17/20)
In this session Jordan Lake discusses fat tissue, adipose tissue (AT), and its role along with metabolic complications, in causing metabolic disturbances PLWH experience, that contribute to body changes (lipoatrophy, belly fat gain, trunk fat) & comorbidities. She discusses inflammation, causes for these metabolic disturbances, that HIV itself enter AT in acute infection, that gender(sex) differences are relevant, the legacy fat of lipoatrophy & its affect on pro-inflammatory environment.
"People who are not adherent (or interruption of therapy [ATI] !!!!!) may have higher inflammation even if retaining <50 c/ml, due to low replication"
CROI: Themed Discussion FAT IN FOCUS - (03/11/20)
this was an oral season with several posters highlighted and reports on them by their authors. Here are 2 slides by the moderator Jacqueline Capeau listing risk factors for weight gain....
not listed in this picture is mitochondrial damage, a legacy affect in PLWH. Jules
Comorbidities at CROI - mortality, aging ..... - (04/20/20)
MITOCHONDRIAL DNA, COGNITIVE FUNCTION, AND FRAILTY IN OLDER ADULTS WITH HIV (03/17/20)
In this study we show a relationship between elevated levels of plasma mtDNA and lower performance on the MoCA, greater exhaustion, and slower walk, suggesting mtDNA may have a role as a novel biomarker in assessing pathogenic inflammation associated with cognitive dysfunction and some components of frailty in PLWH.
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FAT GAINS OCCUR AFTER ART WITHOUT CHANGES IN METABOLIC RATE OR CALORIC INTAKE
CROI 2020
Reported by Jules Levin
Allison Ross Eckard1, Abdus Sattar2, Jiao Yu2, Heather Y. Hughes1, Danielle Labbato3, Theresa O. Rodgers3 , Julia C. Kosco3 , Grace A. McComsey2,3
1Medical University of South Carolina, Charleston, South Carolina, USA; 2Case Western Reserve University, Cleveland, Ohio, USA; 3University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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