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Combination of high liver and visceral fat predict diabetes in people living with HIV
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IAS 2021 July 18-22
Milic J, Renzetti S, Ferrari D, Besutti G, Barbieri S, Ca/za S, Ascari F, Carli F, Cuomo G, Gozzi L, Ligabue G, Cervo A, Mussini C, Sebastiani G, Guaraldi G
University of Modena and Reggio Emilia, Modena, Italy
University of Brescia, Italy
McGill University, Montreal, Quebec, Canada
Abstract:
BACKGROUND: The objective was to investigate the relationship between diabetes mellitus (DM) and concordant or discordant visceral adipose tissue (VAT)-liver fat (LF) phenotypes in people living with HIV (PLWH).
METHODS: 186 individuals from Modena HIV Metabolic Clinic, Italy were contemporary assessed for VAT using lumbar computed tomography imaging and for LF using transient elastography. High VAT was defined as above the median (VAT>174.5 cm2 for men and 144 cm2 for women). High LF was defined as controlled attenuation parameter '¥248 dB/m. Four phenotypes, mutually exclusive, were defined: low VAT-low LF (VAT-LF-), low VAT-high LF (VAT-LF+), high VAT-low LF (VAT+LF-) and high VAT-high LF (VAT+LF+). Bayesian networks were applied to identify the interplay among the different predictors of DM through a Directed Acyclic Graph (DAG).
RESULTS: The study cohort consisted of 14% females with a median age of 57 (51.3-61) years and body mass index (BMI) of 24.9 (22.8-27.3) kg/m2. The prevalence of fat phenotypes were: VAT-LF- 35.5%, VAT-LF+ 13.4%, VAT+LF- 18.8% and VAT+LF+ 32.3%. DM prevalence was 20.4% (38 cases). The Bayesian network depicted in Figure 1 shows the direct effect of age and VAT on DM, while the association between LF and DM is mediated by VAT. Both VAT and LF were associated with DM in separate logistic regressions. Another logistic regression highlighted a higher risk of DM in presence of both VAT and LF (OR=4.2, Cl=1.5-12.6, p=0.006).
CONCLUSIONS: The combination of high LF and high VAT identifies a clinical phenotype with enhanced risk of DM. The DAG model confirms the interaction of HIV duration on VAT, but not on LF, suggesting specific HIV pathways in the continuum of metabolic changes in PLWH.
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