Low Skeletal Muscle Mass in Virally Suppressed HIV Patients
Low Skeletal Muscle Mass in Virally Suppressed HIV Patients
Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.
Life expectancy for people with HIV infection receiving combination antiretroviral therapy (cART) has increased markedly and is expected to approach that of the general population. In New York State alone, over 75% of people living with HIV infection are older than 40 years of age, and 40% are 50 years of age or older. Long-term survival in some HIV-infected persons may be accompanied by chronic immune activation that may potentiate age-related low-grade inflammation, cellular senescence, and physiologic decline. Maximizing disability-free life expectancy has now become a focus of attention in HIV medicine and research.
Sarcopenia, central to the etiology of frailty, precedes age-associated physical disability and is defined as age-related loss of skeletal muscle mass and function. In contrast, presarcopenia is defined as age-related loss of skeletal muscle mass only. Investigators have documented age-related decline in skeletal muscle mass initiating in the third or fourth decade and becoming prominent after 50 years of age in the general population. As a result, older persons may have difficulty executing instrumental activities of daily living and experience social isolation. With more severe skeletal muscle deficit, they may experience a predisposition to falls and fragility fractures with ensuing physical disability, leading to dependence. In a predominantly midlife European HIV cohort, one-half of subjects performed poorly in tests of lower limb muscle performance and balance.
Skeletal muscle volume is the predominant determinant of mid-upper arm circumference (MUAC) in nonobese persons. Determination of MUAC is recommended by the United Nations Subcommittee on Nutrition in the assessment of adult undernutrition. Limb skeletal muscle and MUAC have been independently associated with all-cause mortality in community–dwelling, HIV-infected midlife adults and midlife and older adults without known HIV infection. In addition, MUAC has been validated as a screening tool for undernutrition in a number of settings (ie, antenatal care, geriatrics, etc).
The goals of the present study were to determine the prevalence of sarcopenia and presarcopenia in community-dwelling HIV-infected persons aged 45 years or older stably receiving cART. Additionally, since limb skeletal muscle constitutes more than 75% of total body skeletal muscle and is independently associated with femoral neck bone mineral density, we evaluated the predictive value of MUAC for sarcopenia and presarcopenia.
Abstract and Introduction
Abstract
Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.
Introduction
Life expectancy for people with HIV infection receiving combination antiretroviral therapy (cART) has increased markedly and is expected to approach that of the general population. In New York State alone, over 75% of people living with HIV infection are older than 40 years of age, and 40% are 50 years of age or older. Long-term survival in some HIV-infected persons may be accompanied by chronic immune activation that may potentiate age-related low-grade inflammation, cellular senescence, and physiologic decline. Maximizing disability-free life expectancy has now become a focus of attention in HIV medicine and research.
Sarcopenia, central to the etiology of frailty, precedes age-associated physical disability and is defined as age-related loss of skeletal muscle mass and function. In contrast, presarcopenia is defined as age-related loss of skeletal muscle mass only. Investigators have documented age-related decline in skeletal muscle mass initiating in the third or fourth decade and becoming prominent after 50 years of age in the general population. As a result, older persons may have difficulty executing instrumental activities of daily living and experience social isolation. With more severe skeletal muscle deficit, they may experience a predisposition to falls and fragility fractures with ensuing physical disability, leading to dependence. In a predominantly midlife European HIV cohort, one-half of subjects performed poorly in tests of lower limb muscle performance and balance.
Skeletal muscle volume is the predominant determinant of mid-upper arm circumference (MUAC) in nonobese persons. Determination of MUAC is recommended by the United Nations Subcommittee on Nutrition in the assessment of adult undernutrition. Limb skeletal muscle and MUAC have been independently associated with all-cause mortality in community–dwelling, HIV-infected midlife adults and midlife and older adults without known HIV infection. In addition, MUAC has been validated as a screening tool for undernutrition in a number of settings (ie, antenatal care, geriatrics, etc).
The goals of the present study were to determine the prevalence of sarcopenia and presarcopenia in community-dwelling HIV-infected persons aged 45 years or older stably receiving cART. Additionally, since limb skeletal muscle constitutes more than 75% of total body skeletal muscle and is independently associated with femoral neck bone mineral density, we evaluated the predictive value of MUAC for sarcopenia and presarcopenia.