HIV infection is associated with a greater risk for abdominal obesity and, perhaps indirectly, a greater risk for elevated LDL cholesterol and hypertriglyceridemia, according to recent findings.
In contrast, people with HIV are less likely to have hypertension than those who are not infected, researchers wrote in Clinical Infectious Diseases.
“Our study suggests that abnormal fat distribution and abdominal obesity remain prominent features of contemporarily treated people living with HIV [PLWH] and may contribute to continued excess risk of premature cardiovascular disease in this population, given both the deleterious interaction found between HIV infection and aging in causing abdominal obesity and its association with elevated LDL cholesterol, hypertriglyceridemia and hypertension,” Marco Gelpi, MD, a clinical research team member in the Viro-immunology Research Unit at the University of Copenhagen, and colleagues wrote.
The researchers cited previous studies showing associations between combination ART (cART) regimens used before 2005 — as opposed to HIV infection itself — and abdominal obesity. However, Gelpi and colleagues were not willing to discount that more recent cART regimens could possibly contribute to obesity issues.
“These results suggest that either HIV per se or modern cART may contribute to fat redistribution syndrome as this remains a problem even in contemporary treated PLWH,” they wrote.
Between March 2015 and December 2016, the researchers enrolled participants in the Copenhagen Comorbidity in HIV Infection (COCOMO) study, which tracks the burden of non-AIDS comorbidities among PLWH. Gelpi and colleagues matched 1,099 PLWH in COCOMO to 12,161 control participants without HIV.
Participants underwent blood pressure tests, along with waist, hip, height and weight measurements. They also submitted nonfasting blood samples.
The researchers found that HIV infection was associated with a nearly twofold risk for abdominal obesity compared with controls (adjusted OR = 1.92; 95% CI, 1.6-2.3). That association increased with age, as the risk for abdominal obesity among participants aged 20 to 45 years was significantly lower than that among those aged 60 to 89 years (aOR = 1.46, 95% CI, 1.06-2 and aOR= 2.75; 95% CI, 1.75-4.73, respectively).
HIV was also associated with significantly greater risks for elevated LDL cholesterol (aOR = 1.32; 95% CI, 1.09-1.59), but only after adjusting for body mass index. It was also associated with a greater risk for hypertriglyceridemia (aOR = 1.76; 95% CI, 1.49-2.08). However, PLWH were 37% less likely to have hypertension (aOR = 0.63; 95% CI, 0.54-0.74), the researchers found. They said this finding contradicted their hypothesis that the risk for hypertension would increase with HIV infection, as did the other cardiovascular diseases.
Gelpi and colleagues noted that other studies have had mixed results, with some showing an increased risk for hypertension with HIV infection and some showing a decreased risk.
“There is no obvious biological mechanism that would explain why HIV infection should protect against hypertension, and we suggest that the association found between HIV infection and low risk of hypertension may be due to confounding factors we were not able to account for,” they wrote. “It is worth noticing that this finding was mainly driven by undiagnosed, and thus untreated, hypertension, which may represent a more pronounced white-coat effect in the uninfected population, less exposed to a hospital environment compared to PLWH.”
Additional results showed that abdominal obesity was associated with elevated LDL cholesterol (aOR = 1.44; 95% CI, 1.23-1.69), hypertension (aOR = 1.32; 95% CI, 1.16-1.49) and hypertriglyceridemia (aOR = 2.12; 95% CI, 1.86-2.41).
The researchers concluded that their findings call for action targeting cardiovascular risks among patients with HIV.
“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 of cardiovascular disease in PLWH,” they wrote. – by Joe Green
Gelpi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.