Anthropometrics and Examiner-Reported Body Habitus Abnormalities in the Multicenter AIDS Cohort Study

Clinical Infectious Diseases, Mar 2004

We undertook anthropometric assessments of 530 HIV-seropositive and 314 HIV-seronegative men in the Multicenter AIDS Cohort Study at a regular visit that occurred between 1 April and 30 September 1999. We found anthropomorphic differences that were independent of age: the 384 seropositive men receiving HAART had diminished body size and higher frequency and severity of body habitus abnormalities, particularly lipoatrophy, compared with the 314 seronegative men.

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Anthropometrics and Examiner-Reported Body Habitus Abnormalities in the Multicenter AIDS Cohort Study

Anthropometrics and Examiner- Reported Body Habitus Abnormalities in the Multicenter AIDS Cohort Study Frank J. Palella Stephen R. Cole 1 Joan S. Chmiel 2 Sharon A. Riddler 4 Barbara Visscher 3 Adrian Dobs 1 Carolyn Williams 0 0 National Institute of Allergy and Infectious Diseases, National Institutes of Health , Rockville, Maryland , USA 1 Johns Hopkins University , Baltimore 2 Northwestern University , Chicago, Illinois , USA 3 University of California , Los Angeles , USA 4 University of Pittsburgh , Pennsylvania , USA We undertook anthropometric assessments of 530 HIVseropositive and 314 HIV-seronegative men in the Multicenter AIDS Cohort Study at a regular visit that occurred between 1 April and 30 September 1999. We found anthropomorphic differences that were independent of age: the 384 seropositive men receiving HAART had diminished body size and higher frequency and severity of body habitus abnormalities, particularly lipoatrophy, compared with the 314 seronegative men. - Widespread use of HAART since 1996 has resulted in marked and durable declines in HIV-associated mortality and morbidity, with consequent improvements in quality of life. Potent viral suppression and CD4+ cell count repletion achieved in HAART-treated persons has resulted in an extension of AIDSfree survival time, as well as increased survival time following the onset of clinical AIDS [ 1–3 ]. Within 2 years after the introduction of HAART, reports of diverse metabolic and body habitus abnormalities among HAART recipients began to emerge. These metabolic and body habitus abnormalities included elevations in serum lipid and glucose levels, as well as body site–specific lipoaccumulation and lipoatrophy [ 4–6 ]. Collectively, these findings have been called “lipodystrophy syndrome.” Indeed, much investigative energy has been expended to establish a standard case definition that could (1) accommodate all the identified, and variably expressed, clinical components, (2) link observed abnormalities to one another or to shared pathophysiologic mechanisms, and (3) establish the strength and nature of associations between the abnormalities noted and specific antiretroviral therapy received. Long-term comparisons of body habitus and other metabolic alterations in HIV-infected and uninfected persons over time are only now beginning to be done. Such studies seek, in part, to evaluate possible increased cardiovascular risk consequent to HIV-associated lipodystrophy syndrome [ 7, 8 ]. Herein we report on anthropometrics and examiner-reported body habitus abnormalities in a cross-sectional analysis of 844 men. Methods. The Multicenter AIDS Cohort Study (MACS), with sites in Baltimore, Chicago, Los Angeles, and Pittsburgh, is a prospective study of the natural history of HIV disease that began in 1984 and enrolled 5622 men by 1991 [ 9 ]. At their 31st MACS visit, which occurred between 1 April and 30 September 1999, a total of 869 men completed a detailed interview and underwent a physical examination that included both anthropometric measurements (height; weight; and upper arm, thigh, waist, and hip circumferences) obtained using a standardized protocol based on the Third National Health and Nutrition Examination Survey (NHANES III) [ 9 ] and examiner-reported body habitus alterations. Training for examiners included review of written guidelines and use of a NHANES instructional videotape. Examiners assessed fat loss in the upper arms, legs, buttocks, and face, as well as fat accumulation in the abdomen, breast, and back of neck, and the presence of moon facies. Body habitus alterations were scored as “none,” “mild,” “moderate” or “severe.” Mild signs were defined as those noticeable only upon close inspection, moderate signs as those noticeable upon inspection, and severe signs as those easily noted upon casual observation. Height and weight were measured to the nearest inch and pound using a clinical stadiometer and balance scale, respectively. Waist and hip circumferences were recorded to the nearest centimeter, and arm and thigh girths were recorded to the nearest millimeter by tape measure. Results were restricted to the 844 (of 869) men for whom the examiner reports had complete data. CD4+ cell counts were determined by flow cytometry at National Institute of Allergy HIV/AIDS • CID 2004:38 (15 March) • 903 Variable Breast None Mild Moderate/severe NHANES III HIV-negative (n p 314) None (n p 78) … … … and Infectious Diseases (NIAID) Flow Cytometry Quality Assessment Program–certified laboratories [ 10 ]. Plasma HIV-1 RNA titers were determined by the isothermal nucleic acid sequence–based amplification method in National Institutes of Health (NIH) Virology Quality Assurance–certified laboratories, with a lower limit of detection of 50 copies/mL. Institutional review boards of participating institutions approved study protocols and forms, and participants provided written informed consent. In addition to the MACS dat (...truncated)


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Palella, Frank J., Cole, Stephen R., Chmiel, Joan S., Riddler, Sharon A., Visscher, Barbara, Dobs, Adrian, Williams, Carolyn. Anthropometrics and Examiner-Reported Body Habitus Abnormalities in the Multicenter AIDS Cohort Study, Clinical Infectious Diseases, 2004, pp. 903-907, Volume 38, Issue 6, DOI: 10.1086/381684