HIV Treatment Bulletin - Vol. 6, No. 1, December 2004 / January 2005
Graham McKerrow, HIV i-Base

Weight loss in the HAART era may be driven by residual HIV infection in cells of the monocyte/macrophage lineage, conclude Shikuma and colleagues from the University of Hawaii after a study involving 67 HIV-positive people, a subset of the Hawaii Aging with HIV longitudinal cohort study.

Catabolic cytokines such as TNF-alpha are often elevated in HIV-positive people who have received ARV therapy. Residual HIV infection in cells of the M/M-omega lineage have been found in ARV-treated people who have undetectable plasma HIV-1 RNA.

The researchers hypothesised that weight loss might be secondary to residual HIV infection in these cells with resultant increases in catabolic cytokine production and release.

They analysed the patients’ PBMC proviral DNA copies/cell, select plasma cytokine levels and weight records over the last year of follow-up. Approximately 17% had weight loss > 10 %, 15% had weight loss from > 5% to 10%, 60% maintained stable weight (less than 5% gain or loss), and 6% gained weight.

PBMC proviral DNA levels were higher in those with weight loss > 5% compared to those with stable or increasing weight [median 8.9 vs 0.9 copies/106 cells; p=0.006]. Proviral DNA levels remained higher in the 52% of subjects with plasma HIV RNA levels < 50 copies/mL [median 8.9 vs 0.5 copies/106 cells, p=0.028]. Analysis of HIV DNA in subsets of PBMCs showed that the majority of proviral DNA copies in PBMCs were in activated (CD14+/CD16+) macrophages.

Ref: Shikuma C M, Valcour V, Ratto-Kim S et al. Loss of weight in the era of HAART is associated with elevated PBMC proviral DNA levels. 6th Lipodystrophy Workshop (6th IWADRLH), Washington. Antiviral Therapy 2004; 9(6):L35 Abstract 57.

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