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FAT QUALITY IS INDEPENDENTLY ASSOCIATED WITH CARDIOMETABOLIC RISK IN HIV INFECTION
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Reported by Jules Levin
CROI 2018 March 4-7 Boston Mass
JE Lake1, 2, C Moser3, L Johnston3, C Magyar2, S Nelson2, KM Erlandson4, TT Brown5 and GA McComsey6
1University of Texas Health Science Center at Houston, Houston, TX, USA; 2University of California, Los Angeles, CA, USA; 3Harvard University, Boston, MA,
USA; 4University of Colorado, Denver, CO, USA; 5Johns Hopkins University, Baltimore, MD, USA; 6Case Western Reserve University, Cleveland, OH, USA
Program abstract:
Adipose tissue (AT) quality and quantity may have independent metabolic effects. Computed tomography (CT)-quantified abdominal subcutaneous AT (SAT) density reflects biopsy-quantified SAT adipocyte size in HIV-infected adults, with lower density reflecting larger, poorer quality adipocytes. We assessed relationships between SAT and visceral AT (VAT) density and cardiometabolic and inflammatory parameters among HIV-1-infected adults enrolled in a completed ART initiation trial.
AIDS Clinical Trials Group study A5224s participants were included in baseline analyses (n=54) if they had both abdominal SAT biopsy and CT data, and 96-week analyses (n=30) if they remained on their original randomized antiretroviral therapy (ART) regimen, had HIV-1 RNA <50 copies/mL and had biopsy or CT data. Partial Spearman's correlations adjusting for AT area assessed relationships between AT density (in Hounsfield Units, HU) and metabolic and inflammatory parameters. The Jonckheere-Terpstra test assessed significance in metabolic syndrome analyses.
At baseline, median age was 40 years, CD4+ T lymphocyte count 219 cells/mm3, body mass index (BMI) 26.0 kg/m2, SAT area 199 cm2 and density -100 HU, VAT area 83 cm2 and density -83 HU; 89% were male and 67% white. Greater baseline SAT density correlated with lower triglyceride levels; greater VAT density correlated with higher HDL cholesterol (Table).
Baseline AT density did not correlate with HOMA-IR nor inflammatory biomarker levels. The number of metabolic syndrome components (0, 1-2, 3+) at baseline increased as VAT density decreased (-75, -83 and -90 HU, p=0.002), irrespective of total adiposity (BMI <25 p=0.02, BMI 25+ p=0.04). Over 96 weeks of ART, SAT (+18%) and VAT (+35%) area increased, and SAT (-3%) and VAT (-6%) density decreased. Decreases in SAT HU correlated with increases in hs-CRP, IL-6, soluble TNFRI/II and sICAM-1 independent of SAT area (Table). Decreases in VAT HU correlated with increases in IL-6 and soluble TNFRII independent of VAT area.
SAT and VAT quality, as measured by CT density, are associated with metabolic disturbances in ART-naïve HIV-infected adults, and inflammatory biomarker concentrations on ART, independent of AT quantity. Increased AT area and decreased AT density on ART (suggestive of hypertrophic AT expansion) is associated with increased systemic inflammation and has important implications for comorbidity development following ART initiation.
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