Abdominal obesity, sarcopenia, and osteoporosis are associated with frailty in men living with and without HIV

Hawkins, Kellie; Zhang, Long; Ng, Derek K.; Althoff, Keri N.; Palella, Frank J.; Kingsley, Lawrence; Jacobson, Lisa P.; Margolick, Joseph B.; Lake, Jordan E.; Brown, Todd T.; Erlandson, Kristine M.

doi:10.1097/qad.0000000000001829

Cited by 61 publications

(66 citation statements)

References 50 publications

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“…Sarcopenia is diagnosed in the presence of low values for the first two criteria, whereas it is considered severe when also the third criterion is met [1]. In PLWH, a large number of studies have assessed the prevalence and described the characteristics of one or more of these parameters taken separately, which were usually altered compared to the general population [9,27]. For instance, low muscle strength and impairment of physical performance are often found to be impaired in PLWH and these parameters are indeed used in the definition of frailty, another common syndrome in people ageing with HIV [27][28][29].…”

Section: Epidemiological and Clinical Aspects Of Sarcopenia In Peoplementioning

confidence: 99%

“…In PLWH, a large number of studies have assessed the prevalence and described the characteristics of one or more of these parameters taken separately, which were usually altered compared to the general population [9,27]. For instance, low muscle strength and impairment of physical performance are often found to be impaired in PLWH and these parameters are indeed used in the definition of frailty, another common syndrome in people ageing with HIV [27][28][29]. On the other hand, the assessment of muscle quality and volume by CT showed significantly lower muscle density and greater fat infiltration in PLWH compared to HIV-uninfected controls [30], whereas DEXA studies of body composition show that treated HIV-infected persons gain more fat, but lose lean mass over time compared with HIV-uninfected persons [31].…”

Section: Epidemiological and Clinical Aspects Of Sarcopenia In Peoplementioning

confidence: 99%

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The Role of Physical Activity for the Management of Sarcopenia in People Living with HIV

Bonato

Turrini

Galli

et al. 2020

IJERPH

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Sarcopenia is a physiopathological process associated with aging, caused by reduction of muscle strength, muscle quality and physical performance, and associated with an increased risk of falls, physical disability and premature death. There is no effective treatment for sarcopenia, but physical exercise seems to be highly effective at counteracting the decline in muscle mass and strength associated with aging. Recently, sarcopenia has been recognized as an emerging issue in people living with HIV (PLWH). Despite adequate treatment with combination antiretroviral therapy (cART), PLWH may exhibit an early occurrence of some aging-related conditions, including sarcopenia, frailty and falls, and this is likely resulting from high rates of comorbidities, high-risk behaviours, chronic immune activation and cART-specific factors. In this review, we discuss the potential mechanisms and the clinical relevance of sarcopenia in PLWH, and present data from longitudinal studies of physical activity in this population. Despite none of these studies having specifically addressed the benefits of physical exercise on sarcopenia, there is evidence that exercise is effective to increase aerobic capacity and muscle strength, and to improve body composition and inflammatory outcomes in PLWH. Therefore, the expected benefits of physical exercise are likely to translate into a successful and specific intervention for prevention and treatment of sarcopenia in this population.

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Section: Epidemiological and Clinical Aspects Of Sarcopenia In Peoplementioning

confidence: 99%

Section: Epidemiological and Clinical Aspects Of Sarcopenia In Peoplementioning

confidence: 99%

The Role of Physical Activity for the Management of Sarcopenia in People Living with HIV

Bonato

Turrini

Galli

et al. 2020

IJERPH

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“…Rather, patients with either low VAT or high VAT are at increased risk of frailty after accounting for age, diagnosis, sex, forced vital capacity, BMI, and skeletal muscle mass. While the biomedical literature has tended to focus on the association between sarcopenia and frailty, our findings are consistent with a smaller body of work demonstrating an association between obesity and frailty in the general population . Notably, we are the first to identify a nonlinear relationship between VAT and frailty.…”

Section: Discussionmentioning

confidence: 99%

“…Prior work has focused on the role of muscle mass in the pathogenesis of frailty; adipose tissue has not been studied in frailty in advanced lung disease. In multiple prospective cohort studies of community‐dwelling adults, baseline obesity, particularly central obesity of which VAT is the primary component, is associated with increased risk of frailty . Given the growing prevalence of obesity in the United States, VAT may be an increasingly important risk factor for frailty in advanced lung disease.…”

Section: Discussionmentioning

confidence: 99%

“…Baseline obesity, particularly central obesity, is associated with an increased risk of frailty in large prospective cohorts of community‐dwelling older adults independent of age, sex, physical activity, and comorbidities . Increased abdominal visceral adipose tissue (VAT) in particular is associated with frailty in middle‐aged men . In obesity, VAT is characterized by a proinflammatory phenotype promoted by adipose tissue macrophages, increased CD8 + T cells, and interleukin‐6 (IL‐6) and tumor necrosis factor alpha production .…”

Section: Introductionmentioning

confidence: 99%

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A nonlinear relationship between visceral adipose tissue and frailty in adult lung transplant candidates

Anderson

Kolaitis

Gao

et al. 2019

American Journal of Transplantation

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Frailty is a state of decreased physiologic reserve associated with poor outcomes before and after lung transplantation. Obesity, particularly central obesity characterized by excess proinflammatory visceral adipose tissue (VAT), is associated with incident frailty in middle-aged and older adults. The association between VAT and frailty in advanced lung disease, however, is unknown. In two, nonoverlapping multicenter cohorts of adults listed for lung transplantation, we measured VAT area on bioelectrical impedance assay (BIA) in one cohort and cross-sectional VAT and subcutaneous adipose tissue (SAT) areas on abdominal computed tomography (CT) in the other. We identified a nonlinear relationship between greater VAT by BIA and frailty. In fully adjusted piecewise regression models, every 20 cm 2 increase in VAT area was associated with 50% increased odds of frailty in subjects with high VAT (95% CI 1.2-1.9, P < .001), and 10% decreased odds of frailty (95% CI 0.7-1.04, P = .12) in subjects with low VAT. Compared to frail subjects with low VAT, those with high VAT were more likely to have low grip strength and less likely to have weight loss, suggesting that mechanisms of frailty may differ by VAT. Further investigation of mechanisms linking VAT and frailty may identify new targets for prevention and treatment. K E Y W O R D Sclinical research/practice, lung transplantation/pulmonology, obesity, quality of life (QOL)

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Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Saag

Gandhi

Hoy

et al. 2020

JAMA

368

227

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ImportanceData on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices.ObjectiveTo evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV.Evidence ReviewNew evidence was collected since the previous International Antiviral (formerly AIDS) Society–USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations.FindingsFrom 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic.Conclusion and RelevanceAdvances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.

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Abdominal obesity, sarcopenia, and osteoporosis are associated with frailty in men living with and without HIV

Abstract: Higher abdominal obesity and sarcopenia were associated with frailty among men with and without HIV. Assessment of these body composition parameters may help detect frailty in the clinical setting.

Cited by 61 publications

References 50 publications

The Role of Physical Activity for the Management of Sarcopenia in People Living with HIV

The Role of Physical Activity for the Management of Sarcopenia in People Living with HIV

A nonlinear relationship between visceral adipose tissue and frailty in adult lung transplant candidates

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

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