9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 19-21 July 2007, Sydney, Australia

RELATIONSHIP OF BODY COMPOSITION, ANTIRETROVIRAL USE, AND HIV DISEASE FACTORS TO ENDOTHELIAL DYSFUNCTION IN HIV-INFECTED SUBJECTS

Antiviral Therapy 2007; 12(Suppl. 2):L15 (abstract no. O-19)

MP Dubé, C Shen, JS Waltz, ML Greenwald, K Mather and SK Gupta
Indiana University School of Medicine, Indianapolis, IN, USA

BACKGROUND: Vascular endothelial dysfunction may contribute to the increase in cardiovascular events during HIV-1 infection and its treatment. Antiretroviral therapy (ART) including protease inhibitor (PI) use, metabolic factors, lipodystrophy, and HIV infection itself may all contribute to this endothelial dysfunction.

METHODS: Ninety-six HIV-infected subjects had evaluation of endothelial function by measurement of brachial artery flow-mediated dilation (FMD) by ultrasound, plus single slice CT of the abdomen and mid-thigh, whole-body dual X-ray absorptiometry (DXA) scans, and metabolic evaluations in a cross-sectional study.

RESULTS: Median age was 40.4 years, 28% were female, 38% black, 3% Hispanic, 59% white. Forty-nine (51%) were receiving ART, which included PI in 28 (57%) and was non-PI-based in 21 (43%). FMD (±SD) in subjects not on ART was 5.5 ±4.3%, PI-ART 5.3 ±3.6%, and non-PIART 5.5 ±4.1% (P=0.9). Age, race, CD4 cell count, and HIV RNA did not correlate significantly with FMD. Females had significantly higher FMD than males (P=0.01, t-test). Among ART-treated subjects in the lowest tertile of DXA limb fat as percent of total body fat (range 18.6–36.5%), FMD was 3.7 ±2.8% and in the highest tertile (range 43.3–60.9%) FMD was 6.3 ±3.7% (P=0.03, t-test). Among ART-treated subjects in the lowest tertile of CT thigh subcutaneous (SC) fat area (range 3–31 cm²), FMD was 4.4 ±3.5% and in the highest tertile (range 67–237 cm²) FMD was 6.8 ±3.6% (P=0.07). Among ART-treated subjects in the lowest tertile of CT visceral to subcutaneous abdominal fat (VAT/SAT) ratio (range 0.12–0.33), FMD was 6.7 ± 2.9% and in the highest tertile (range 0.65–4.42) FMD was 5.7 ±4.1% (P=0.5). The body fat measure that correlated most closely with FMD in ART-treated s`ubjects was thigh fat area (r=0.22, P=0.12).

CONCLUSIONS: ART use, PI use, CD4 cell count, and HIV RNA levels were not associated with endothelial dysfunction by brachial FMD. Among subjects receiving ART, those with lower limb fat percent and lower thigh SC fat area tended to have worse endothelial function. This suggests that lipoatrophy may be an important contributor to endothelial dysfunction in HIV-infected individuals on ART.

Acknowledgements: This work was supported by the NHLBI (grant R01 HL72711) and NCRR (grant RR-00750).

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2007-07-24
O-19

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