High Prevalence of Low Skeletal Muscle Mass Associated with Male Gender in Midlife and Older HIV-Infected Persons Despite CD4 Cell Reconstitution and Viral Suppression

Abstract

Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m(2)) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.

A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation

“…To our knowledge, the negative impact of these 2 morbidities has not previously been reported in the literature. In the most recent series about HIV patients, sarcopenia was often described according to the European consensus with muscle mass being calculated as appendicular skeletal muscle mass/height 2 . This definition is not specific to HIV status, and the cutoffs were not calculated in this specific population.…”

Chapter 2 Epidemiology of sarcopenia

“…Based on two reports, the prevalence of sarcopenia among HIV‐infected patients was calculated (applying the EWGSOP criteria) to be 5.0% ( n = 80, mean age 54 years) and 24.2% ( n = 33, mean age 59 years) …”

Prevalence and predictors of low muscle mass in HIV/viral hepatitis coinfection

“…37 MUAC captures the loss of peripheral tissue stores of protein and muscle, has been used previously as a marker of low muscle mass in HIV and viral hepatitis populations, 8,20,38,39 and has been independently associated with increased mortality. 8,9,30,40 Use of anthropometric measurements to determine muscle mass is less likely to be subject to misclassification in chronic liver disease compared to other traditional measures of malnutrition, including body mass index (BMI) or serum markers (e.g.…”