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Long-term body composition changes in antiretroviral-treated HIV-infected individuals

Philip M Grant¹, Douglas Kitch, Grace A McComsey

¹aDivision of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California bCenter for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts cDivision of Infectious Diseases, Departments of Pediatrics and Medicine, Case Western Reserve University, Cleveland, Ohio dDivision of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington eNew England Research Institute, Watertown, Massachusetts fDivision of Infectious Diseases, Department of Medicine, Ohio State University, Columbus, Ohio gDivision of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado hDivision of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California iDivision of Infectious Diseases, Department of Medicine, Columbia University, New York, New York jGilead Sciences, Foster City, California kViiv Healthcare, Research Triangle Park, Durham, North Carolina lDivision of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

AIDS (London, England)

|September 24, 2016

Abstract

Objective:

Body composition impacts physical function and mortality. We compared long-term body composition changes after antiretroviral therapy (ART) initiation in HIV-infected individuals to that in HIV-uninfected controls.

Design:

Prospective observational study.

Methods:

We performed dual-energy x-ray absorptiometry (DXA) approximately 7.5 years after initial DXA in available HIV-infected individuals who received DXAs during the randomized treatment trial AIDS Clinical Trials Group A5202. For controls, we used DXA results from HIV-uninfected participants in the Boston Area Community Health/Bone and Women's Interagency HIV Study cohorts. Repeated measures analyses compared adjusted body composition changes between HIV-infected and HIV-uninfected individuals. Multivariable analyses evaluated factors associated with body composition change in HIV-infected individuals.

Results:

We obtained DXA results in 97 HIV-infected and 614 HIV-uninfected participants. Compared with controls, HIV-infected individuals had greater adjusted lean mass and total, trunk, and limb fat gain during the first 96 weeks of ART. Subsequently, HIV-infected individuals lost lean mass compared with controls. Total, trunk, and limb fat gains after 96 weeks of ART slowed in HIV-infected individuals but remained greater than in controls. Lower CD4 T-cell count was associated with lean mass and fat gain during the initial 96 weeks of ART, but subsequently no HIV-related characteristic was associated with body composition change.

Conclusion:

Consistent with a 'return to health effect', HIV-infected individuals, especially those with lower baseline CD4 T-cell counts, gained more lean mass and fat during the first 96 weeks of ART than HIV-uninfected individuals. Continued fat gain and lean mass loss after 96 weeks may predispose HIV-infected individuals to obesity-related diseases and physical function impairment.

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