Normal weight obesity is associated with hypercholesterolemia and low muscle mass in persons living with HIV on antiretroviral treatment.

OBJECTIVES: Normal weight obesity (NWO) is defined as a condition of normal body weight, but with high body fat percentage. Clinical and immunologic implications of NWO in persons living with HIV (PLHIV) remain unknown. The aim of this study was to examine NWO prevalence and its associations with metabolic and immunologic measurements in a cohort of PLHIV on antiretroviral treatment (ART). METHODS: We enrolled 73 adult PLHIV on ART. Body composition was assessed by dual-energy x-ray absorptiometry. NWO was defined as body mass index 18.5 to 24.9 kg/m2 and body fat ≥25%. We determined triacylglycerols, total cholesterol, high-density lipoprotein, low-density lipoprotein, blood glucose, blood pressure, bone mineral density, inflammatory cytokines (interleukin [IL]-1ß, tumor necrosis factor-α and IL-6) and CD4+ and CD8+ T-cell activation. RESULTS: The prevalence of NWO was 49% (36 of 73). Participants with NWO showed lower CD4+ T-cell percentage (25 versus 27%, P = 0.03), lower CD4/CD8 ratio (0.62 versus 0.82, P = 0.02), lower muscle mass (6.84 versus 7.11 kg/m2, P = 0.01) and higher prevalence of hypercholesterolemia (26% versus 6%, P = 0.03) than individuals with normal body composition. No differences in inflammation/activation markers were observed between groups (P > 0.05 in all cases). CONCLUSION: NWO was frequent in a cohort of Mexican PLHIV on ART and was associated with lower muscle mass, hypercholesterolemia, lower CD4+ T-cell percentage, and lower CD4/CD8 ratio. The incorporation of body fat measurements in the regular physical examination of PLHIV could contribute to early identification of the NWO condition and lead to better management of possible long-term morbidity.

Novel HLA class I associations with HIV-1 control in a unique genetically admixed population.

Associations between HLA class I alleles and HIV progression in populations exhibiting Amerindian and Caucasian genetic admixture remain understudied. Using univariable and multivariable analyses we evaluated HLA associations with five HIV clinical parameters in 3,213 HIV clade B-infected, ART-naïve individuals from Mexico and Central America (MEX/CAM cohort). A Canadian cohort (HOMER, n = 1622) was used for comparison. As expected, HLA allele frequencies in MEX/CAM and HOMER differed markedly. In MEX/CAM, 13 HLA-A, 24 HLA-B, and 14 HLA-C alleles were significantly associated with at least one clinical parameter. These included previously described protective (e.g. B*27:05, B*57:01/02/03 and B*58:01) and risk (e.g. B*35:02) alleles, as well as novel ones (e.g. A*03:01, B*15:39 and B*39:02 identified as protective, and A*68:03/05, B*15:30, B*35:12/14, B*39:01/06, B*39:05~C*07:02, and B*40:01~C*03:04 identified as risk). Interestingly, both protective (e.g. B*39:02) and risk (e.g. B*39:01/05/06) subtypes were identified within the common and genetically diverse HLA-B*39 allele group, characteristic to Amerindian populations. While HLA-HIV associations identified in MEX and CAM separately were similar overall (Spearman's rho = 0.33, p = 0.03), region-specific associations were also noted. The identification of both canonical and novel HLA/HIV associations provides a first step towards improved understanding of HIV immune control among unique and understudied Mestizo populations.