Suchergebnisse

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

BackgroundWe examined whether the combination of waist (WC) and thigh (ThC) circumference improves the prediction of visceral adipose tissue (VAT) over WC and ThC independently in HIV‐infected men and women after correction for age. We also examined the independent associations between VAT, and the combination of WC and ThC with metabolic risk factors, metabolic syndrome, type 2 diabetes mellitus (T2DM) and prior cardiovascular events in HIV‐infected individuals.MethodsConsecutive patients attending the metabolic clinic of the University of Modena in Italy between 2005 and 2009 were recruited in this cross‐sectional study. Total and regional fat mass and lean mass were quantified using DEXA. A single CT image was taken for quantification of VAT and CAC. Prior cardiovascular events which occurred within a 5‐year period of the clinical evaluation were analysed. A cross‐fold test was used to explore different models in the ability to predict VAT in order to build an algorithm for VAT estimation (e‐VAT). Regression analysis were performed to determine the univariate and multivariate relations between WC, ThC, and age with VAT. A comparison of beta coefficients for VAT and e‐VAT to predict cardio‐metabolic risk and events were performed using multivariable regression models after correction for BMI and age.Results2322 HIV‐infected patients were recruited: median duration of HIV infection was 182 months (IQR 126–236); median nadir and current CD4 were 172 (IQR 68–262) and 515.5 (IQR 369–700) and 75% of them had undetectable HIV1‐VL. In this abstract only the results of men will be presented. Men (n=1481) had a mean age of 45.9±7.3 years, a BMI of 24.1 ± 3.8 kg/m2, a WC of 88.0±10.1 cm and a ThC of 47.8±4.3 cm. e‐VAT algorithm for men was: (5.44*WC)−(1.35*ThC)−(1.70*age)−348.1 In men, at multivariable regression models after correction for BMI and age, e‐VAT was concordant to VAT in predicting HOMA, MetS Risk, prior cardiovascular events (OR=1.01), was better than VAT in predicting T2DM (OR=1.00) and CAC>10 (OR=1.01) but was worse than VAT in predicting TC/HDL and TG.DiscussionWe confirm that ThC is inversely associated to VAT after correction for WC. e‐VAT is a sensitive tool to predict VAT more accurately than WC and ThC independently. e‐VAT proved to predict cardio‐metabolic risks and events in men and women, qualifying this variable for a potential clinical use.

BackgroundHIV‐infected postmenopausal women have higher rates of bone loss than HIV negative women. We aimed to identify predictors of body mass density (BMD) in HIV infected women entering menopause and to evaluate the pre‐ and post‐menopausal BMD change, with regard to tenofovir (TDF) use.MethodsWomen with at least one DEXA measurement were enrolled. The observation period was divided into: "Reproductive period", "Menopause transition period", "Early menopause period", "Late menopause period". BMD of the lumbar spine (L1‐4) and femur neck were measured by DEXA. Lowess smoothing curves were drawn to analyze impact of menopause and TDF on BMD. Three different longitudinal linear regression models with random effects were built. Longitudinal regression analysis fits cross sectional time series regression models and allows to analyze repeated measures for each patient.ResultsFifty‐five women were included. Median age at enrollment was 46 years (IQ range 44–49). Median observation period was 16 months (IQ range 8; 23) and 33 months (IQ range 23; 72) for pre‐ and post‐menopausal respectively. At enrollment mean CD4 cell count was 553 cell/mL (±269.62) and HIV‐VL was undetectable in 77.5% of patients: 6 women were not undergoing ART. Most common backbone TDF/FTC (46.9%) and ABC/3TC (20.4%). At the time of inclusion in the cohort osteopenia and ostoeporosis were present in 60% and 3.64%, respectively. At the time of last DEXA evaluation osteopenia and osteoporosis were present in 78.18% and 36.36%, respectively. The impact of menopause on lumbar BMD was depicted (fig. 1) using a lowess smoothing analysis according to current TDF exposure (as treated model). Lumbar BMD change predictors were years from menopause and TDF current exposure in the "Early menopause period" and years from menopause, Baseline lumbar BMD, BMI and vitD supplementation in the "Late menopause period".DiscussionThis is the first study analyzing BMD across menopause. BMD was stable in the pre‐menopause period while BMD loss characterized the post‐menopause period. Traditional risk factors contributed to BMD change in the post ‐menopause period. Current TDF exposure was independently associated with BMD change in the "Early menopause period" only, but not confirmed in the "Late menopause period", suggesting a compensating mechanism occurring after the second year post‐menopause.
image
















Transitional period
Early menopause
Late menopause



β
95% CI
p‐value
β
95% CI
p‐value
β
95% CI
p‐value




Years to (from*) menopause
−0.1
−0.03; 0.01
0.407
−0.01
−0.02; − 0.01
<0.001
−0.1
−0.2; − 0.003
0.009


Baseline lumbar BMD
0.0002
−0.001; 0.003
0.078
0.0002
−0.0001; 0.0004
0.074
0.9
0.70−1.09
<0.001


PTH
−0.0005
−0.001; 0.0004
0.280
0.0001
−0.0004; 0.0002
0.535
−0.0001
−0.0002; 0.0002
0.800


BMI
0.003
−0.005; 0.010
0.489
0.004
−0.001; 0.010
0.142
0.008
0.002; 0.014
0.010


VitD supplementation
−0.003
−0.05; 0.04
0.865
0.008
−0.010; 0.026
0.392
0.03
0.001; 0.054
0.038


TDF current exposure
−0.03
−0.07; 0.01
0.125
−0.03
−0.05; −0.01
0.012
−0.04
−0.09; 0.01
0.129