Cabrera Diego M, Cornejo Mijahil P, Pinedo Yvett, Garcia Patricia J, Hsieh Evelyn
Department of Internal Medicine, Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut, United States of America.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
PLOS Glob Public Health. 2023 Aug 18;3(8):e0000814. doi: 10.1371/journal.pgph.0000814. eCollection 2023.
Management of chronic conditions and optimization of overall health has become a primary global health concern in the care of people living with HIV in the era of highly active antiretroviral therapy (ART), particularly in lower-and-middle income countries where infrastructure for chronic disease management may be fragmented. Alterations in body composition can reflect important changes in musculoskeletal health, particularly among populations at risk for developing fat and muscle redistribution syndromes, such as women with HIV on ART. Given the lack of data on this topic in Latin America and the Caribbean, we designed an exploratory study to measure these outcomes in a population of women aging with HIV in Peru. We conducted a cross-sectional study among Peruvian women with and without HIV aged ≥40 years. Dual X-ray absorptiometry was used to measure trunk and limb lean mass (LM) and fat mass (FM). Physical performance was assessed with the Short Physical Performance Battery (SPPB) and physical strength with a dynamometer. Sarcopenia was assessed based upon EWGSOP criteria. We used linear regression to model associations between body composition, sarcopenia and physical performance scores. 104 women with HIV and 212 women without HIV were enrolled (mean age 52.4±8.2 vs. 56.4±8.8 years, p≤0.001). Among women with HIV, mean years since diagnosis was 11.8±6 and all were on ART. Mean SPPB score was 9.9 vs 10.8 (p<0.001) between both groups. Sarcopenia spectrum was found in 25.9% and 23.1%, respectively. In the multivariable regression analysis, trunk FM and older age were negatively correlated with physical performance among women with HIV. Severe sarcopenia was found among a greater proportion of those with HIV (3.8% vs. 0.9%, p = 0.84), however this finding was not statistically significant. Women with HIV had significantly lower SPPB scores compared to women without HIV, and trunk FM and upper limb LM were independent predictors for the SPPB and Grip Strength tests, respectively. Larger, prospective studies are needed in Latin America & the Caribbean to identify individuals at high risk for sarcopenia and declines in physical function, and to inform prevention guidelines.
在高效抗逆转录病毒治疗（ART）时代，慢性病管理和整体健康状况优化已成为全球关注的主要艾滋病护理问题，尤其是在中低收入国家，这些国家的慢性病管理基础设施可能不完善。身体成分的改变可以反映肌肉骨骼健康的重要变化，特别是在有脂肪和肌肉重新分布综合征风险的人群中，例如接受抗逆转录病毒治疗的感染艾滋病病毒的女性。鉴于拉丁美洲和加勒比地区缺乏关于这一主题的数据，我们设计了一项探索性研究，以测量秘鲁感染艾滋病病毒的老年女性人群中的这些结果。我们对年龄≥40岁的秘鲁感染和未感染艾滋病病毒的女性进行了一项横断面研究。使用双能X线吸收法测量躯干和四肢的瘦体重（LM）和脂肪量（FM）。使用简短身体性能量表（SPPB）评估身体性能，使用测力计评估体力。根据欧洲老年人肌肉减少症工作组（EWGSOP）标准评估肌肉减少症。我们使用线性回归来建立身体成分、肌肉减少症和身体性能评分之间的关联模型。招募了104名感染艾滋病病毒的女性和212名未感染艾滋病病毒的女性（平均年龄分别为52.4±8.2岁和56.4±8.8岁，p≤0.001）。在感染艾滋病病毒的女性中，自诊断以来的平均年数为11.8±6年，所有女性均接受抗逆转录病毒治疗。两组的平均SPPB评分分别为9.9和10.8（p<0.001）。肌肉减少症谱分别在25.9%和23.1%中发现。在多变量回归分析中，躯干脂肪量和年龄较大与感染艾滋病病毒的女性的身体性能呈负相关。在感染艾滋病病毒的人群中发现严重肌肉减少症的比例更高（3.8%对0.9%，p = 0.84），然而这一发现无统计学意义。与未感染艾滋病病毒的女性相比，感染艾滋病病毒的女性的SPPB评分显著更低，躯干脂肪量和上肢瘦体重分别是SPPB和握力测试的独立预测因素。拉丁美洲和加勒比地区需要开展更大规模的前瞻性研究，以确定肌肉减少症和身体功能下降的高危个体，并为预防指南提供依据。
