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Antiretroviral initiation is associated with increased skeletal muscle area and fat content.

Antiretroviral initiation is associated with increased skeletal muscle area and fat content.
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Erlandson KM, Fiorillo S, Masawi F, Scherzinger A, McComsey GA, Lake JE, Stein JH, Currier JS, Brown TT,


Erlandson KM, Fiorillo S, Masawi F, Scherzinger A, McComsey GA, Lake JE, Stein JH, Currier JS, Brown TT, (click to view)

Erlandson KM, Fiorillo S, Masawi F, Scherzinger A, McComsey GA, Lake JE, Stein JH, Currier JS, Brown TT,

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AIDS (London, England) 31(13) 1831-1838 doi 10.1097/QAD.0000000000001558

Abstract
OBJECTIVE
A greater burden of physical function impairment occurs in HIV-infected adults; the impact of antiretroviral therapy (ART) initiation on muscle density (less dense = more fat), a measure of muscle quality, is unknown.

DESIGN
AIDS Clinical Trials Group Study A5260s, a cardiometabolic substudy of A5257, randomized HIV-infected, ART-naive adults to ritonavir-boosted atazanavir, darunavir, or raltegravir with tenofovir/emtricitabine backbone. Single-slice abdominal computed tomography scans from baseline and week 96 were reanalyzed for total and lean muscle area and density.

METHODS
Two-sample t-tests described the differences between baseline and week 96 variables. Linear regression analysis was used to explore the role of a priori identified variables and potential confounders.

RESULTS
Participants (n = 235) were mostly men (90%); 31% were Black non-Hispanic; 21% were Hispanic. Over 96 weeks, small but significant increases were seen in oblique/transverse abdominal, rectus, and psoas muscle total area (range 0.21-0.83 cm; P < 0.05) but not the lean muscle component (all P ≥ 0.33). Significant decreases in overall density, consistent with increases in fat, were seen in all muscle groups (range -0.87 to -2.4 HU; P < 0.01); for the lean muscle component, only decreases in oblique/transverse abdominal and rectus reached statistical significance (P < 0.05). In multivariable analyses, Black race was associated with increased muscle density and female sex with decreased density; treatment arm was not associated with changes in mass or density. CONCLUSION
The ART-associated increase in muscle area, regardless of regimen, is likely a reflection of increased fat within the muscle. The consequences of fatty infiltration of muscle on subsequent muscle function require further investigation.

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