Prevalence and predictors of low muscle mass in HIV/viral hepatitis coinfection

Abstract

Objective: Low muscle mass is associated with reduced survival in HIV, possibly mediated by systemic inflammation. Viral hepatitis coinfection can induce additional inflammation and hepatic dysfunction that may exacerbate low muscle mass. We determined the prevalence of and risk factors for low muscle mass in HIV/viral hepatitis coinfection.

Design and methods: A cross-sectional study of participants in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study with anthropometry performed after 1 January 2000. Viral hepatitis defined by positive hepatitis B virus surface antigen and/or hepatitis C virus RNA. Low muscle mass defined as less than 10th percentile of age-matched and sex-matched reference values for mid-upper arm circumference. Using multivariable logistic regression, we determined adjusted odds ratios with 95% confidence intervals (CIs) of the association of HIV/viral hepatitis coinfection with low muscle mass and factors associated with low muscle mass in coinfected persons. Analyses adjusted for age, race, BMI, alcohol use, and IDU (also, nadir CD4 cell count and HIV RNA where appropriate).

Results: Among 3518 participants (164 HIV/viral hepatitis, 223 viral hepatitis alone, 1070 HIV alone, and 2061 uninfected), HIV/viral hepatitis-coinfected persons had a 3.50-fold (95% CI, 1.51-8.09), 1.93-fold (1.17-3.20), and 2.65-fold (1.62-4.35) higher odds of low muscle mass than viral hepatitis-monoinfected, HIV-monoinfected, and uninfected persons, respectively. Lack of HIV RNA suppression [odds ratio, 2.26 (95% CI, 1.10-4.63)] was the only factor associated with low muscle mass in coinfected persons.

Conclusion: HIV/viral hepatitis-coinfected persons have a higher likelihood of low muscle mass than those with viral hepatitis monoinfection, HIV monoinfection, or neither infection. HIV viremia is an important risk factor for low muscle mass among coinfected persons.

Figure 1

Selection of HIV/viral hepatitis-coinfected, HIV-monoinfected, viral hepatitis-monoinfected, and uninfected participants from the Multicenter AIDS Cohort (MACS) and Women’s Interagency HIV Study (WIHS) for inclusion in the study. Abbreviations: AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; HIV, human immunodeficiency virus; MACS, Multicenter AIDS Cohort Study; WIHS, Women’s Interagency HIV Study

Figure 2

Association between HIV/viral hepatitis-coinfected participants and low muscle mass, as compared to HIV-monoinfected, viral hepatitis-monoinfected and uninfected persons. * All models adjusted for age, sex, race/ethnicity, body mass index, active alcohol use, and active injection drug use. Model comparing HIV/viral hepatitis coinfected to HIV monoinfected patients was additionally adjusted for HIV viral load and nadir CD4 count.