Sarcopenic Obesity Phenotypes in Patients With HIV: Implications for Cardiovascular Prevention and Rehabilitation

Background: To describe prevalence, incidence and risk factors for sarcopenic obesity (SO) phenotypes in people living with HIV (PWH) and their association with subclinical cardiovascular disease (CVD). Methods: Observational, longitudinal study of PWH. A minimum of one criterion was necessary to diagnose sarcopenia: (i) weak hand grip (HG), (ii) low appendicular skeletal muscle index (ASMI), (iii) short physical performance battery (SPPB <11). Obesity was defined as (i) body mass index (BMI) ≥30 kg/m2 or (ii) visceral adipose tissue (VAT) ≥160 cm2. These variables combined generated five SO phenotypes: (i) severe SO: low HG+ low ASMI + low SPPB + high BMI; (ii) SO1: weak HG + high VAT; (iii) SO2: weak HG + high BMI; (iv) SO3: low ASMI + high VAT; (v) SO4: low ASMI + high BMI. Subclinical CVD was defined as carotid intima media thickness (IMT) ≥1 mm, presence of carotid plaque, or CAC score >10. Results: Among 2379 PWH 72% men, median age was 52 years, median HIV vintage 21 years, and median BMI 24 kg/m2. Two PWH had severe SO. The prevalence of SO1-SO4 was 19.7%, 3.6%, 20.8% and 0.8% respectively. Incidence of SO1-SO4 was 6.90, 1.2, 5.6 and 0.29 x 100 persons-year, respectively. SO1 was associated with risk of IMT ≥ 1, and SO3 with risk of CAC score >10. Conclusions: There was a large variability in incidence and prevalence of SO phenotypes. The presence of SO may have important implications for cardiovascular prevention and cardiac rehabilitation of PWH who suffered an event.