Abstract
The distribution of body size phenotypes in people with human immunodeficiency virus (HIV) infection has yet to be characterized. We assessed the distribution of body size phenotypes overall, and according to antiretroviral therapy (ART), diagnosed duration of the infection and CD4 count in a sample of HIV infected people recruited across primary care facilities in the Western Cape Province, South Africa. Adults aged ≥ 18 years were consecutively recruited using random sampling procedures, and their cardio-metabolic profile were assessed during March 2014 and February 2015. They were classified across body mass index (BMI) categories as normal-weight (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2), and further classified according to their metabolic status as “metabolically healthy” vs. “metabolically abnormal” if they had less than two vs. two or more of the following abnormalities: high blood glucose, raised blood pressure, raised triglycerides, and low HDL-cholesterol. Their cross-classification gave the following six phenotypes: normal-weight metabolically healthy (NWMH), normal-weight metabolically abnormal (NWMA), overweight metabolically healthy (OvMH), overweight metabolically abnormal (OvMA), obese metabolically healthy (OMH), and obese metabolically abnormal (OMA). Among the 748 participants included (median age 38 years (25th–75th percentiles: 32–44)), 79% were women. The median diagnosed duration of HIV was five years; the median CD4 count was 392 cells/mm3 and most participants were on ART. The overall distribution of body size phenotypes was the following: 31.7% (NWMH), 11.7% (NWMA), 13.4% (OvMH), 9.5% (OvMA), 18.6% (OMH), and 15.1% (OMA). The distribution of metabolic phenotypes across BMI levels did not differ significantly in men vs. women (p = 0.062), in participants below vs. those at or above median diagnosed duration of HIV infection (p = 0.897), in participants below vs. those at or above median CD4 count (p = 0.447), and by ART regimens (p = 0.205). In this relatively young sample of HIV-infected individuals, metabolically abnormal phenotypes are frequent across BMI categories. This highlights the importance of general measures targeting an overall improvement in cardiometabolic risk profile across the spectrum of BMI distribution in all adults with HIV.
Highlights
People living with human immunodeficiency virus (HIV) infection constitute a sizable proportion of the world population and the number is increasing [1]
We considered the following four abnormalities: (1) elevated blood pressure (BP)
Blood samples from six participants were inadequate for analyses resulting in 748 (99%) participants being included in the study
Summary
People living with HIV infection constitute a sizable proportion of the world population and the number is increasing [1]. The lifespan of HIV infected patients receiving ART is close to that of the general population [3]. This has led to a rise in chronic and age-related conditions such as cardio-metabolic disorders in HIV-infected people [4,5], that is contributing substantially to the overall morbidity and mortality in this population [6,7]. Obesity contributes to cardio-metabolic abnormalities by impairing metabolic functions that promote dyslipidemia, insulin resistance, as well as chronic inflammation [9] Concepts such as “metabolically healthy” and “metabolically abnormal” have been used to characterize individuals across the distribution of body mass index (BMI) as a function of the underlying burden of metabolic abnormalities [10]
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