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Associations Between Central Obesity and Lifelong Antiviral Therapy in Adults Living With HIV Acquired From Early Childhood
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Seynt Jiro Sahagun, BA,a Teja Yeramosu, BA,a Julia B. Purdy, MSN, CRNP,b
James C. Reynolds, MD,c and Colleen M. Hadigan, MD, MPHa
Methods:
We conducted a prospective study of adults with perinatal HIV (n = 70) using dual-energy X-ray absorptiometry and standard anthropometrics. Trunk to limb fat ratio and waist to hip ratio were compared cross-sectionally to 47 matched controls. Furthermore, changes in body composition and ARV exposure were evaluated longitudinally in a subset of 40 PLWH with a median follow-up of 7 years.
Results:
Cross-sectional comparisons of PLWH with controls revealed significantly higher waist to hip ratio, trunk to limb fat ratio, HOMA-IR, and triglycerides, whereas BMI did not differ. Among PLWH with longitudinal follow-up, the prevalence of overweight increased from 27.5% to 52.5% and obesity from 12.5% to 25%; waist to hip and trunk to limb fat ratios also increased (P < 0.0001). Changes in waist to hip ratio were positively correlated with longer exposure during follow-up to darunavir (r = 0.36; P = 0.02), whereas increases in trunk to limb fat ratio were positively correlated with longer exposure to stavudine (r = 0.39; P = 0.01) and didanosine (r = 0.39; P = 0.01) but inversely associated with emtricitabine (r = -0.33; P = 0.04). Increases in waist to hip ratio were correlated with increases in triglyceride levels (r = 0.35; P = 0.03).
Only HDL-c significantly increased while there were no significant changes in total cholesterol, LDL-c, triglycerides, blood pressure, insulin, or HOMA-IR. During the course of follow-up, 10% (4/40) of PLWH received antihypertensive medications and 20% (8/40) received lipid-lowering medications. The median duration of ARV exposure during follow-up by class and individual agents are included in Table 1
In conclusion, individuals who acquired HIV in early childhood were more likely to demonstrate central obesity compared with those without HIV. Using DEXA scans and anthropometrics, we measured body fat distribution over an average of 7 years. We also identified associations between body composition and metabolic parameters as well as the duration of exposure to certain ARVs. These findings underscore the long-term persistence and associated risk factors of central adiposity among PLWH who have lifelong ARV exposure which may translate to increased metabolic disturbances and enhanced risk of cardiovascular disorders in future decades.
In this natural history study, young adults who acquired HIV in early childhood demonstrated a heightened risk for metabolic disorders compared with those without HIV. Hyperlipidemia and insulin resistance were both strikingly common among PLWH. Body fat distribution also tended to be central with adipose tissue accumulation preferentially in the truncal region, relative to those without HIV. Although BMI and biomarkers for lipid and glucose metabolism did not change significantly between baseline and last follow-up, noticeable increases in waist to hip circumference ratio and trunk to limb fat ratio were observed and may reflect the residual lipodystrophic effects of extensive ARV use since early childhood and adolescence.
The increased prevalence of MetS among individuals with perinatally acquired HIV has been demonstrated in previous studies. In particular, Auripubul et al15 reported 10.6% MetS prevalence among Thai adolescents living with HIV with a mean age of 20 years. Arrive et al16 also reported a 13.2% and 10.4% prevalence of MetS among French men and women of the same age group, respectively. Within our cohort, we identified similar results with a 13% prevalence of MetS among PLWH, which, although not significantly different from the 4% among non-HIV controls, may represent a meaningful progression of metabolic disorders among this young adult cohort. Older PLWH, regardless of HIV acquisition history, have been identified to have significantly higher rates of MetS relative to comparator groups.17,18 For example, in a large cohort of PLWH in Spain, Jerrico et al18 found that MetS increased from 5.1% in those younger than 30 years to 27% in those aged 50–59 years, indicating exacerbation of known age-related increase in risks for cardiovascular disorders among those living with HIV. These findings highlight the need for careful monitoring of individual components of MetS among this cohort, specifically dyslipidemia, glucose intolerance, and abdominal obesity.
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