A lower body mass index is associated with cardiomyopathy in people with HIV infection: Evidence from a case comparison study

Lemmer, Carolina Elisabet; Badri, Motasim; Visser, Marianne E; Mayosi, Bongani M.

doi:10.7196/samj.4348

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…Of the thirteen studies that were included in our systematic review (7) , three were not eligible for this IPDMA: one was conducted prior to 2000 (8) and two had sample sizes <100 (20,21) . We attempted to contact the researchers from the remaining ten studies and ultimately received datasets from two of them.…”

Section: Methodsmentioning

confidence: 99%

Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

Tang

Chung

Dong

et al. 2020

Public Health Nutr.

107

129

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Objective: To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women). Design: We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed. Setting: Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included. Participants: All eligible participants from the original datasets were included. Results: The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61–0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight. Conclusions: MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.

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Section: Methodsmentioning

confidence: 99%

Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

Tang

Chung

Dong

et al. 2020

Public Health Nutr.

107

129

View full text Add to dashboard Cite

show abstract

“…Malnutrition has been postulated to be a contributory factor, and, in a recent study, patients with HIV-associated cardiomyopathy had evidence of undernutrition compared with HIV-infected people without cardiomyopathy (body mass index 20.9 vs 27.0 kg/m 2 , p=0.02), and a lower body mass index was the only independent anthropometric risk factor for cardiomyopathy (OR 0.76, 95% CI 0.64 to 0.97, p=0.02) 27. The role of genetic factors in HIV-associated cardiomyopathy is largely not known.…”

Section: Hiv-associated Cardiomyopathymentioning

confidence: 99%

Recent advances in HIV-associated cardiovascular diseases in Africa

Syed

Sani

2013

Heart

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The last decade has witnessed major advances in our understanding of the epidemiology and pathophysiology of HIV-related cardiovascular disease in sub-Saharan Africa. In this review, we summarise these and discuss clinically relevant advances in diagnosis and treatment. In the Heart of Soweto Study, 10% of patients with newly diagnosed cardiovascular disease were HIV positive, and the most common HIV-related presentations were cardiomyopathy (38%), pericardial disease (13%) and pulmonary arterial hypertension (8%). HIV-related cardiomyopathy is more common with increased immunosuppression and HIV viraemia. With adequate antiretroviral therapy, the prevalence is low. Contributing factors such as malnutrition and genetic predisposition are under investigation. In other settings, pericardial disease is the most common presentation of HIV-related cardiovascular disease (over 40%), and over 90% of pericardial effusions are due to Mycobacterium tuberculosis (TB) pericarditis. HIV-associated TB pericarditis is associated with a greater prevalence of myopericarditis, a lower rate of progression to constriction, and markedly increased mortality. The role of steroids is currently under investigation in the form of a randomised controlled trial. HIV-associated pulmonary hypertension is significantly more common in sub-Saharan Africa than in developed countries, possibly as a result of interactions between HIV and other infectious agents, with very limited treatment options. It has recently been recognised that patients with HIV are at increased risk of sudden death. Infection with HIV is independently associated with QT prolongation, which is more marked with hepatitis C co-infection and associated with a 4.5-fold higher than expected rate of sudden death. The contribution of coronary disease to the overall burden of HIV-associated cardiovascular disease is still low in sub-Saharan Africa.

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“…Selenium supplementation improves cardiac function in PLHIV in small studies (46,47), but the debate as to whether HIV-associated LVSD responds to selenium supplementation is unresolved. Nonetheless, there is evidence of association between lower body mass index and LVSD in PLHIV, suggesting that overall nutrition may be a factor (48). …”

Section: Causes Of Hiv-associated Hfmentioning

confidence: 99%

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

Bloomfield

Alenezi

Barasa

et al. 2015

JACC: Heart Failure

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Successful combination therapy for human immunodeficiency virus (HIV) has transformed this disease from a short-lived infection with high mortality to a chronic disease associated with increasing life expectancy. This is true for high- as well as low- and middle-income countries. As a result of this increased life expectancy, people living with HIV are now at risk of developing other chronic diseases associated with aging. Heart failure has been common among people living with HIV in the eras of pre- and post- availability of antiretroviral therapy; however, our current understanding of the pathogenesis and approaches to management have not been systematically addressed. HIV may cause heart failure through direct (e.g., viral replication, mitochondrial dysfunction, cardiac autoimmunity, autonomic dysfunction) and indirect (e.g., opportunistic infections, antiretroviral therapy, alcohol abuse, micronutrient deficiency, tobacco use) pathways. In low- and middle-income countries, 2 large observational studies have recently reported clinical characteristics and outcomes in these patients. HIV-associated heart failure remains a common cardiac diagnosis in people living with heart failure, yet a unifying set of diagnostic criteria is lacking. Treatment patterns for heart failure fall short of society guidelines. Although there may be promise in cardiac glycosides for treating heart failure in people living with HIV, clinical studies are needed to validate in vitro findings. Owing to the burden of HIV in low- and middle-income countries and the concurrent rise of traditional cardiovascular risk factors, strategic and concerted efforts in this area are likely to impact the care of people living with HIV around the globe.

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A lower body mass index is associated with cardiomyopathy in people with HIV infection: Evidence from a case comparison study

Cited by 8 publications

References 13 publications

Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

Recent advances in HIV-associated cardiovascular diseases in Africa

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

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