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. 2021 Feb 13;223(3):462-470.
doi: 10.1093/infdis/jiaa373.

Association of Male Sex and Obesity With Residual Plasma Human Immunodeficiency Virus 1 Viremia in Persons on Long-Term Antiretroviral Therapy

Joshua C Cyktor  1 , Ronald J Bosch  2 , Hanna Mar  2 , Bernard J Macatangay  1 , Ann C Collier  3 , Evelyn Hogg  4 , Catherine Godfrey  5 , Joseph J Eron  6 , Deborah K McMahon  1 , John W Mellors  1 , Rajesh T Gandhi  7 ; ACTG A5321 Team
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Association of Male Sex and Obesity With Residual Plasma Human Immunodeficiency Virus 1 Viremia in Persons on Long-Term Antiretroviral Therapy

Joshua C Cyktor et al. J Infect Dis. .

Abstract

Background: Although adipose tissue has been proposed to harbor part of the human immunodeficiency virus 1 (HIV-1) reservoir, the influence of host characteristics, including sex and body mass index (BMI), on measures of HIV-1 persistence during antiretroviral therapy (ART) are incompletely understood.

Methods: We evaluated age, sex, BMI, waist circumference, years on ART, pre-ART HIV-1 RNA, pre-ART CD4+ T-cell count, and initial ART regimen with measures of HIV-1 persistence in blood (residual viremia, cellular HIV-1 DNA and RNA) in a cohort of 295 individuals with well-documented long-term virologic suppression (HIV-1 RNA <50 copies/mL) on ART (AIDS Clinical Trials Group study A5321).

Results: Men were more likely than women to have detectable plasma HIV-1 RNA by single-copy assay (52% vs 29%; P = .003), and the proportion of participants with detectable residual viremia increased in a stepwise fashion by BMI category (normal weight or underweight, 38%; overweight, 50%; and obese, 55%). ART regimen type was not associated with measures of HIV-1 persistence after controlling for ART duration.

Conclusions: Sex and obesity are independently associated with residual viremia in people on long-term ART. Additional studies to confirm these relationships and to define the mechanisms by which sex and obesity affect HIV-1 persistence are needed to inform HIV-1 cure strategies.

Keywords: HIV-1; obesity; sex.

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Figures

Figure 1.
Figure 1.
Plasma human immunodeficiency virus 1 (HIV-1) RNA detectability by sex or body mass index (BMI) category. Plasma HIV-1 RNA single-copy assay results for 285 of the 295 participants in AIDS Clinical Trials Group (ACTG) study A5321 were grouped according to participant sex (A) or BMI (B). Illustrated are the proportions of HIV-1 RNA levels >0.4 copies per mL by single-copy assay of approximately 5 mL of plasma. The normal weight/underweight group in B includes 82 normal weight (BMI, 18.5–25) and 2 underweight (BMI <18.5) individuals (BMI calculated as weight in kilograms divided by height in meters squared).
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Comment in

  • Reply.
    Bottanelli M, Ceccarelli D, Galli L, Castagna A, Muccini C. Bottanelli M, et al. J Infect Dis. 2022 Jun 1;225(11):2050-2051. doi: 10.1093/infdis/jiac070. J Infect Dis. 2022. PMID: 35218659 No abstract available.
  • Reply to Bottanelli et al.
    Cyktor JC, Bosch RJ, Mar H, Macatangay BJ, Collier AC, Hogg E, Godfrey C, Eron JJ, McMahon DK, Mellors JW, Gandhi RT; ACTG A5321 Team. Cyktor JC, et al. J Infect Dis. 2022 Jun 1;225(11):2051-2052. doi: 10.1093/infdis/jiac071. J Infect Dis. 2022. PMID: 35381084 No abstract available.

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