Abdominal obesity and elevated LDL a risk for people with HIV

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People living with HIV are at increased risk for abdominal obesity, hypertriglyceridemia, and elevated low-density lipoprotein (LDL) cholesterol but not hypertension, according to a study, led by Susanne Dam Nielsen at the Viro-immunology Research Unit, department of infectious diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, which included 1,099 people living with HIV from the Copenhagen Comorbidity in HIV Infection (COCOMO) study and 12,161 uninfected sex and age-matched controls from the Copenhagen General Population Study.

Each participant was assessed using an identically structured questionnaire to determine demographics, smoking, physical activity, medication, and educational level. HIV infection data were obtained by a review of the COCOMO participants’ medical charts.

All participants were examined by trained clinical staff using identical protocols to determine waist and hip measurements, blood pressure, body mass index (BMI), and blood levels of triglycerides, LDL-C, total cholesterol, glucose, and HbA1c. People living with HIV had lower BMI than the control participants and yet had a higher incidence of abdominal obesity (63.5% vs 59.8%, P =.018). People living with HIV also showed a higher prevalence of hypertriglyceridemia than control participants but a lower prevalence of hypertension. Exploratory analysis showed that an increased risk for metabolic syndrome was associated with HIV infection.

Abdominal obesity is associated with increased risk for cardiovascular disease and cardiovascular disease risk factors. Cardiovascular disease is the principal contributor to non-AIDS mortality and morbidity in people living with HIV. Earlier generations of antiretroviral treatments (ART) for HIV resulted in a high incidence of fat redistribution syndrome, which declined after the introduction of combination ART (cART) with only minor metabolic side effects. However, this study revealed that HIV was associated with an increased risk for abdominal obesity even after stratifying participants according to cART initiation date, suggesting that either HIV itself increases this risk, or modern cART still contributes to fat redistribution syndrome.

At a given BMI, the association between abdominal obesity and HIV was exacerbated by age. The study investigators hypothesise that both age and HIV-associated fat redistribution syndromes are amplified by parallel yet interconnected pathways that lead to a synergistic interaction between HIV infection and ageing.

The investigators conclude that this study suggests fat redistribution syndrome and abdominal obesity remain prominent features of people living with HIV and may partly explain “the continued excess risk for premature cardiovascular disease in this population, given both the deleterious interaction found between HIV infection and ageing in causing abdominal obesity and its association with elevated LDL-C, hypertriglyceridemia, and hypertension. Renewed attention by the medical community (toward) the abdominal obesity phenotype, and innovative interventions targeting this condition are therefore needed in order to reduce the risk (for) cardiovascular disease in people living with HIV.”

Abstract
Background: People living with HIV (PLWH) have lower life expectancy than uninfected individuals, partly explained by excess risk of cardiovascular diseases (CVD) and CVD risk factors. We investigated the association between HIV infection and abdominal obesity, elevated LDL cholesterol (LDL-C), hypertriglyceridemia and hypertension, in a large cohort of predominantly well-treated PLWH and matched controls.
Methods: 1,099 PLWH from the Copenhagen Co-morbidity in HIV infection (COCOMO) study and 12,161 age and sex-matched uninfected controls from the Copenhagen General Population Study were included and underwent blood pressure, waist-, hip-, weight-, and height-measurements. Non-fasting blood samples were obtained from all participants. We assessed whether HIV was independently associated with abdominal obesity, elevated LDL-C, hypertriglyceridemia and hypertension using logistic regression models adjusted for known risk factors.
Results: HIV infection was associated with higher risk of abdominal obesity (adjusted odds ratio (aOR): 1.92[1.60-2.30]) for a given BMI, elevated LDL-C (aOR: 1.32[1.09-1.59]), hypertriglyceridemia (aOR 1.76[1.49-2.08]), and lower risk of hypertension (aOR: 0.63[0.54 – 0.74]). The excess odds of abdominal obesity in PLWH was stronger with older age (p-interaction 0.001). Abdominal obesity was associated with elevated LDL-C (aOR: 1.44[1.23-1.69]), hypertension (aOR: 1.32[1.16-1.49]), and hypertriglyceridemia (aOR: 2.12[1.86-2.41]). Low CD4 nadir and duration of HIV infection were associated with the presence of abdominal obesity (aOR: 1.71[1.12-2.62] and aOR: 1.37/5-years [1.11-1.70]).
Conclusions: Abdominal obesity was associated with proaterogenic metabolic factors including elevated LDL-C, hypertension and hypertriglyceridemia and remains a distinct HIV-related phenotype particularly among older PLWH. Effective interventions to reduce the apparent detrimental impact on cardiovascular risk from this phenotype are needed.

Authors
Marco Gelpi, Shaoib Afzal, Jens Lundgren, Andreas Ronit, Ashley Roen, Amanda Mocraft, Jan Gerstoft, Anne-Mette Lebech, Birgitte Lindegaard, Flaus Fuglsang Kofoed, Børge G Nordestgaard, Susanne Dam Nielsen

Infectious Disease Advisor material
Clinical Infectious Diseases abstract


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