Functional Impairment in Patients With HIV Linked to Higher Cardiometabolic Risk

Low functional impairment among patients with HIV around the world was associated with higher cardiometabolic risk, according to results from REPRIEVE, a prospective, randomized, controlled, phase 3 primary cardiovascular prevention study published in Clinical Infectious Diseases.

The study cohort included adults with HIV aged 40 to 75 years who were treated with antiretroviral therapy (ART) for at least 6 months, had a CD4 T-cell count >100 cells/µL, and had no known cardiovascular disease. Participants were recruited from over 100 sites across 12 different countries. Investigators randomly assigned patients to take either pitavastatin calcium 4 mg daily or placebo.

Investigators classified subgroups of patients in global burden of disease (GBD) super regions based on the location of the enrollment site and using criteria developed by the World Health Organization (WHO). To assess functional capacity, participants completed Duke Activity Status Instrument (DASI) questionnaires, which take metabolic equivalents into account and correlates these with peak oxygen uptake. The higher the DASI score, the less functional impairment.

In total, 7736 participants completed the baseline DASI assessment and were included in the analysis. The majority (n=4065) of participants were from high-income countries and 65% were men.

The greatest reported degree of impairment by DASI score was in South Asia (29% with moderate-severe impairment) and the least degree of impairment was reported in Southeast/East Asia (1% with moderate-severe impairment). In these regions, women, older patients, and Asian or Black compared with White participants reported greater functional impairment.

Single variable analyses showed functional status differed by ART class, with higher functioning reported among those taking nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) + non-nucleoside reverse transcriptase inhibitor (NNRTI) and lowest functioning reported among those taking NRTI-sparing regimens; however, there was a very limited number of participants in this group.

Single variable analyses also showed that factors associated with lower DASI scores included greater body mass index (>30 kg/m²), longer time on ART, and thymidine exposure. Higher DASI scores were associated with higher nadir and total CD4 T-cell count.

When investigators adjusted analyses by GBD region, similar trends were generally seen across all regions, with notable exceptions: poor functional status was associated with cigarette smoking only in high-income regions (P <.001) and was not associated with sex in either site in Asia (P <.001).

Investigators found greater proportions of higher Categories of Atherosclerotic Cardiovascular Disease (ASCVD) risk scores (>7.5%) among participants with some or moderate-severe functional impairment. They also found that moderate-severe impairment was associated with a 1.45 greater odds of having metabolic syndrome (95% CI, 1.20-1.77) and a 1.15 greater odds of having the high waist circumference component of metabolic syndrome (95% CI, 1.10-1.19).

The study was limited by the DASI format which was not adjusted for specific regions.

“While many HIV clinics may prioritize screening for functional impairment among older patients (i.e., those age 50 or older), patients with certain HIV characteristics (low current CD4 count, longer ART or thymidine analogue exposure) may also merit screening as a higher risk population,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Erlandson KM, Fitch KV, McCallum SA, et al. Geographical differences in the self-reported functional impairment of people with HIV and associations with cardiometabolic risk. Clin Infect Dis. Published online February 15, 2022. doi:10.1093/cid/ciac098/6528571