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. 2023 Jul 24;10(8):ofad398.
doi: 10.1093/ofid/ofad398. eCollection 2023 Aug.

Visceral Adiposity Index as a Measure of Cardiovascular Disease in Persons With Human Immunodeficiency Virus

Teressa S Thomas  1 , Carolyn Dunderdale  1 , Michael T Lu  2 , Allie R Walpert  1 , Grace Shen  1 , Michele C H Young  1 , Martin Torriani  3 , Jacqueline T Chu  4 , Hanna H Haptu  4 , Monica Manandhar  4 , Alysse Wurcel  5 , Gail K Adler  6 , Steven K Grinspoon  1 , Suman Srinivasa  1
Affiliations

Visceral Adiposity Index as a Measure of Cardiovascular Disease in Persons With Human Immunodeficiency Virus

Teressa S Thomas et al. Open Forum Infect Dis. .

Abstract

Background: Persons with well-treated human immunodeficiency virus (HIV) demonstrate a 2-fold higher risk of cardiovascular disease (CVD), which may be related to excess visceral adipose tissue (VAT). The visceral adiposity index (VAI) is a score to approximate VAT by combining biochemical measures with anthropometrics without quantification by imaging. We evaluated VAI in association with cardiometabolic factors among persons with HIV (PWH).

Methods: Forty-five PWH on antiretroviral therapy and virologically controlled with increased abdominal VAT (VAT area >110 cm2 on CT) and no known CVD were included. VAI was calculated using standard sex-specific formulas. Coronary plaque was assessed using coronary CT angiography.

Results: Participants were predominantly male (73%), white (53%), and non-Hispanic (84%), with a mean age of 55 (standard deviation, 7) years. Among PWH, median VAI was calculated to be 4.9 (interquartile range [IQR], 2.8-7.3). Log VAI correlated with log VAT (r = 0.59, P < .0001) and anthropometric measures (body mass index: r = 0.36, P = .02; waist circumference: r = 0.43, P = .004; waist-to-hip ratio: r = 0.33, P = .03). Participants with coronary plaque had a higher VAI compared to those without coronary plaque (median, 5.3 [IQR, 3.4-10.5] vs 2.8 [IQR, 1.8-5.0]; P = .004). VAI (area under the curve = 0.760, P = .008) performed better than the atherosclerotic CVD risk score to predict the presence of plaque in receiver operating characteristic analyses.

Conclusions: VAI may be a useful biomarker of metabolic dysfunction and increased CVD risk that may occur with VAT accumulation in PWH.

Clinical trials registration: NCT02740179.

Keywords: HIV; cardiovascular disease; coronary plaque; visceral adipose tissue; visceral adiposity index.

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Conflict of interest statement

Potential conflicts of interest. S. S. was the recipient of a Gilead Sciences Research Scholars award. M. T. L. has received research funding from KOWA, MedImmune, AstraZeneca, Ionis, and Johnson & Johnson Innovation. S. K. G. has received research funding from KOWA, Gilead, ViiV, and Theratechnologies; has received consulting fees from Theratechnologies and ViiV; and is a member of the scientific advisory board of Marathon Asset Management, all unrelated to the present work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Comparison of visceral adiposity index (VAI) among people with human immunodeficiency virus (PWH) without known cardiovascular disease in the absence or presence of plaque as assessed on coronary computed tomography angiography. Box plot represents the 25th and 75th percentiles and line within the box represents the median. VAI was higher among PWH with presence of any coronary plaque compared to those without any presence of plaque (median, 5.3 [interquartile range {IQR}, 3.4–10.5] vs 2.8 [IQR, 1.8–5.0]; P = .004).
Figure 2.
Figure 2.
Receiver operating characteristic curves for body composition and cardiovascular disease risk indices with CAC >0 (A) and presence of any plaque (calcified, noncalcified, or mixed) (B). Abbreviations: ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CAC, coronary artery calcium score; VAI, visceral adiposity index; VAT, visceral adipose tissue; WC, waist circumference; WHR, waist-to-hip ratio.
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