Functional impairment may increase cardiometabolic risk in people living with HIV

According to this new multinational cohort study, low functional status based on the Duke Activity Status Instrument score was associated with higher cardiometabolic risk in people 45 years and older living with HIV.

According to data from REPRIEVE, a multinational Phase 3 cohort, published in Clinical infectious diseases.

Although previous studies have demonstrated similar results in a specific country or geographic region, none included a multinational population to compare functional impairments across global burden of disease (GBD) regions or to explore how different factors that contribute to varying impairments may exist between regions.

“Indeed, the factors that may contribute to physical functional loads in high-income countries may be markedly different from those that contribute to functional load in sub-Saharan Africa or Asia,” the study authors said. “Furthermore, the HIV epidemics in these regions differ with respect to the proportion of women and the timing and type of antiretroviral therapy (ART) which may influence the development of other comorbidities.”

This study included adults aged 40 to 75 living with HIV who had been receiving ART for at least 6 months; they were randomized to receive either pitavastatin (Livalo) calcium 4 mg daily or a placebo for the study.

A total of 7736 participants were recruited from over 100 sites in 12 countries. All participants had CD4 T cell counts greater than 100 cells/mcL, had no known cardiovascular disease, and were at traditional low to moderate risk for atherosclerotic cardiovascular disease (ASCVD).

5-3% of participants were from high-income countries, 65% were men, and 48% had received ART for at least 10 years. The Duke Activity Status Instrument (DASI) was used to categorize participants according to level of impairment: none, moderate, moderate, and severe.

Sixty-four percent reported no impairment, 28% some impairment and 8.2% moderate impairment; 0.31% reported severe impairment. The median DASI score (IQR) was 58.2 (50.2-58.2), the highest score available that reflects the highest functional status, the authors noted.

Adjusted analyzes showed significantly more frequent functional impairment among participants from South Asia, with 96% of participants from this region reporting at least one impairment compared to participants from high-income regions, Latin America and the Caribbean, Southeast and East Asia and Sub-Saharan Africa. Africa.

Although differences were noted between GBD regions, other factors associated with greater functional impairment included:

  • female gender
  • black race
  • Advanced age
  • Current or former smoker
  • Higher body mass index
  • Use of ART for at least 10 years
  • Some ART regimens

The authors also found higher proportions of higher ASCVD risk scores (>7.5%) among participants living with HIV reporting at least one functional impairment.

In addition, moderate to severe impairment was associated with a 45% higher risk of having metabolic syndrome (HR, 1.45; 95% CI, 1.20-1.77) and a 15% higher risk high to have the high waist circumference component of metabolic syndrome (HR, 1.15; 95% CI, 1.10-1.19).

“The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction,” the authors explained. “These longitudinal associations will be further investigated during follow-up to the REPRIEVE trial.”

Reference

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

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