Initial ART Therapy Increases Fat and Lean Body Mass in Patients With HIV

Patients with HIV who are initiating antiretroviral therapy (ART) for the first time show a significant increase in fat and lean body mass during the first few years of treatment, according to results published in The Journal of Clinical Endocrinology & Metabolism.

The study included participants who initiated ART from January 2008 forward (n=146). The researchers conducted prospective ongoing assessments of changes in fat, including clinical evaluation and dual x-ray absorptiometry scan. They also determined arm, leg, trunk, and total fat in addition to fat mass ratios for each participant.

Of the 146 participants, 80% were male, with a mean age of 44 years. Mean HIV-1 RNA viral load was 4.98 log10 copies/mL and mean CD4 count was 254 cells/μL.

The most common initial antiretroviral combinations included non-nucleoside reverse transcriptase inhibitor drugs, followed by protease inhibitor- and integrase strand transfer inhibitor-based regimens.

At month 36, the researchers found an increase in participants’ body mass index (BMI), total fat, trunk fat, and limb fat. After calculating fat mass ratios for each participant, the researchers also found that these increased significantly from baseline for both men and women (both P=.001).

The results indicated that participants receiving non-nucleoside reverse transcriptase inhibitor- or integrase strand transfer inhibitor-based regimens had a marginal but significant increase in fat mass ratio (0.10 and 0.07, respectively; P =.01). This was not observed among participants receiving protease inhibitor-based regimens.

After 60 months of follow up, the researchers had data from 62 participants. All regimen groups, including the protease inhibitor group, showed a significant increase in fat mass ratios at 60 months.

“The return to health in terms of the fat and BMI increase in this immunosuppressed population responding to ART is consistent with the decrease in mortality observed in a previous study by our group,” the researchers wrote.

Reference

Tiraboschi J, Navarro-Alcaraz A, Giralt D, et al. Changes in body fat distribution in antiretroviral-naïve HIV-positive individuals initiating current ART regimens [published online October 26, 2018]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-01489