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)