Sex-specific fat mass ratio cutoff value identifies a high prevalence of cardio-metabolic disorders in people living with HIV

Background and aims: HIV-associated lipodystrophy syndrome (HALS) contributes to the increased cardiovascular risk connoting people living with HIV (PLHIV). HALS recognition, based on clinical ground, may be inaccurate urging an objective instrumental diagnosis. The aim of this study is to search for the DXA-derived fat mass ratio (FMR) threshold, among those suggested for the diagnosis of HALS, able to identify PLHIV at high cardiovascular risk. Methods and results: In a cross-sectional analysis of 101 PLHIV (age 53 +/- 11 years, men 55%) and 101 age- and sex-matched uninfected controls, DXA-derived FMR and anthropometric as well as cardio-metabolic parameters were assessed. PLHIV showed a higher FMR (1.15 +/- 0.42 vs 0.95 +/- 0.18, p < 0.01) together with a greater cardio-metabolic derangement than controls, in spite of lower BMI (24.3 +/- 4.3 vs 26.9 +/- 4.0 kg/m(2), p < 0.01) and fat mass index (FMI, 6.6 +/- 3.0 vs 9.2 +/- 3.1 kg/m(2), p < 0.01). Particularly, PLHIV with HALS (n = 28), defined as those with a FMR above 1.260 and 1.329 for men and women, respectively, had a greater prevalence of type 2 diabetes mellitus (18% vs 1%), insulin resistance (68% vs 27%), hypertriglyceridemia (50% vs 29%), hypertension (61% vs 30%) and metabolic syndrome (32% vs 10%) than those without HALS (p < 0.05 for all comparisons) and controls. At multivariate analyses, FMR in PLHIV was significantly associated (p < 0.05) with fasting glucose (13 [95%0] = 0.5, [0.1-0.9]), insulin (44.6, [14.9-74.2]), HOMA-IR (1.6, [0.5-2.7]), triglycerides (1.0, [ 0.2-1.8]) and HDL-cholesterol (-2.1, [-3.9/-0.4]) levels. Conclusion: Sex-specific FMR thresholds, proposed for diagnosis of HALS, could represent new indices of cardio-metabolic derangement in PLHIV. (C) 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Automated summary

This study aimed to search for the DXA-derived fat mass ratio (FMR) threshold for the diagnosis of HIV-associated lipodystrophy syndrome (HALS) and to identify people living with HIV (PLHIV) at high cardiovascular risk. The study found that PLHIV had higher FMR and cardio-metabolic derangement compared to uninfected controls, despite having lower BMI and fat mass index (FMI). PLHIV with HALS had a higher prevalence of type 2 diabetes, insulin resistance, hypertriglyceridemia, hypertension, and metabolic syndrome compared to those without HALS and controls. FMR was significantly associated with various metabolic parameters in PLHIV.