Original ArticleThe Frequency of Low Muscle Mass and Its Overlap With Low Bone Mineral Density and Lipodystrophy in Individuals With HIV—A Pilot Study Using DXA Total Body Composition Analysis
Introduction
Attendant to the introduction of combination antiretroviral therapy (cART) and the subsequent fall in AIDS-defining complications among infected individuals, there has been a dramatic rise in non–AIDS-related morbidities, many of which have been viewed as the result of premature and accelerated aging 1, 2, 3, 4, 5. Although multiple organ systems are affected by this process, the musculoskeletal system has been prominently involved 5, 6, 7, 8, 9, 10, 11, 12.
Although changes in bone 6, 7, 8, 13, 14, 15, 16, 17, 18 and fat 5, 11, 19, 20, 21, 22, 23, 24 have been studied extensively, muscle has been relatively neglected. Impaired muscle function is a common finding in persons with human immunodeficiency virus (HIV) that so far has gained less attention than osteoporosis (OP) or lipodystrophy (LD). HIV-related causes of muscle function loss include myopathy, distal symmetric polyneuropathy, and wasting syndrome 10, 25, 26, 27, 28. With the introduction of cART, these diseases are encountered less frequently. However, the HIV+ population appears to age at an earlier age and faster pace making them prone to aging-related morbidity 3, 4, 5, 29. Among these diseases are OP and sarcopenia (SP).
The term sarcopenia, the combination of the Greek words “sarc” (flesh) and “penia” (lack of), describes age-related loss of muscle mass and function 30, 31. Similar to HIV-related muscle disorders, SP is thought to have multiple contributing factors, including poor nutrition, inflammation, neuromuscular and mitochondrial dysfunction, and hormonal changes 32, 33, 34. Although controversy persists over the best way to characterize this disease 32, 35, 36, recent consensus definitions have been proposed 37, 38.
The concept of SP is clinically important as it is associated with disability, decreased quality of life, and increased morbidity as well as mortality. Although SP has been mainly described with aging, secondary—disease-related—causes also exist 9, 25, 32, 33, 39, 40, 41. Recent data demonstrate that HIV+ individuals, when compared with noninfected controls, appear to suffer from a number of complications that are traditionally “non-AIDS” related that are often seen in premature aging, including frailty 3, 4, 5, 26, 29, 42, 43, 44. This could indicate that individuals with HIV are particularly prone to SP as they age prematurely and have a chronic disease that impairs muscle function. Indeed, one study found that decreased limb muscle mass and increased central adiposity are associated with increased mortality in individuals with HIV (45).
Although dual-energy X-ray absorptiometry (DXA) is commonly used for the assessment of LD, lean mass, a surrogate for muscle mass, is rarely reported. Moreover, these studies did not use DXA criteria that are becoming more and more accepted to define SP 46, 47, 48, 49, 50. As there is little knowledge about the frequency of muscle impairment and its effect on physical function and quality of life in persons with HIV in the cART era, we felt that the research to examine the prevalence of SP and investigate potential risk factors was urgently needed. Furthermore, we looked for associations between low muscle mass (LMM) and the more widely studied phenomena of low bone mineral density (BMD) and LD.
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Participants
This cross-sectional study was approved by the local institutional review board. HIV+ males both on treatment or treatment naive participated after signing informed consent. Volunteers were recruited from the HIV research database of the Clinical Immunology Department. Apart from HIV status, there were no other inclusion criteria. Individuals with active cancer were excluded from this study.
Body Composition Measurements
DXA is the most widely used method to determine BMD. As it is also able to determine fat and lean mass,
Participants
A total of 66 HIV+ males participated; 57 had received treatment for HIV and 9 were treatment naive. The median age was 41.5 yr with a range from 23 to 68 yr. Median BMI was 24.6 kg/m2 with a range from 18.8 to 33.7 kg/m2. Table 2 shows an overview of the distribution of potential risk factors chosen for this analysis. In brief, treated individuals were older at the time of DXA, had HIV longer, and their nadir CD4 count was lower.
Frequency of Body Composition Abnormalities
There were 2 individuals who only had BMD assessment and not complete
Discussion
Premature aging and thus SP are major problems facing HIV+ patients in the cART and post-cART eras. Few authors have used the term sarcopenia in connection with HIV 9, 39, 45, 58, 59. To our knowledge, no data exist on the frequency of low lean body mass when using proposed DXA criteria for SP, the aLM/height2 ratio, or the regression residual methods described earlier 36, 54, 57. Diagnosing SP could have significant clinical impact as it contributes to increased mortality and morbidity,
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Funding disclosures: None.
Potential conflict of interest: All authors report no potential conflicts of interest related to this work.