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Review
. 2025 Jul 18;80(6):1306-1328.
doi: 10.1093/cid/ciae543.

Morbidity and Mortality Risk Among People With HIV and Central or Visceral Adiposity: A Targeted Literature Review

Alison M Bjornson  1 , Roger J Bedimo  2 , Shelagh M Szabo  1 , Hannah Rochon  1 , Daniel Lee  3
Affiliations
Review

Morbidity and Mortality Risk Among People With HIV and Central or Visceral Adiposity: A Targeted Literature Review

Alison M Bjornson et al. Clin Infect Dis. .

Abstract

Background: Given the known relationship between human immunodeficiency virus (HIV), antiretroviral therapies, and excess visceral adipose tissue (VAT), this review sought to characterize risk of negative health outcomes associated with excess VAT and increased waist circumference (WC) in people with HIV (PWH).

Methods: Comprehensive targeted literature searches were conducted in Medline/Embase (27 June 2022), identifying peer-reviewed articles and conference abstracts reporting on cohorts of PWH. Screening was guided by PECOS (Population, Exposure, Comparator, Outcomes, Study design) criteria. From the included studies, outcomes of interest including mortality and morbidity risk by VAT area and WC were extracted, overall, and by sex, race/ethnicity, and duration of HIV. Relationships between outcome and exposure variables were summarized.

Results: Thirty-five studies were included (sample size range: 31-1748 PWH). Twenty-five studies characterized the relationship between increased WC and negative health outcomes-cardiovascular disease (CVD), arteriosclerosis, hypertension, diabetes, hepatic fat and fibrosis, and cognitive impairment-among PWH. Fifteen studies reported on increased VAT and negative health outcomes: all-cause mortality, CVD, atherosclerosis, hepatic fat, and fibrosis. Importantly, there was a 2.1-times higher odds of 5-year all-cause mortality among PWH with the highest amount of VAT in the only study identified reporting on mortality. Among the studies characterizing the relationship between morbidity and VAT, for example, 1 found that, for each 10-cm2 increase in VAT, the risk of prevalent CVD increased by 1.05 (95% CI: 1.0-1.1) times.

Conclusions: WC may be a useful and cost-effective surrogate for visceral adiposity, which is an important marker of morbidity and mortality among PWH.

Keywords: central adiposity; evidence synthesis; human immunodeficiency virus; visceral adipose tissue; waist circumference.

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Conflict of interest statement

Potential conflicts of interest. A. M. B., H. R., and S. M. S. are employees of Broadstreet HEOR, which received funds from Theratechnologies to conduct this study. R. J. B. and D. L. received consulting fees related to this work. R. J. B. reported receiving research grants/grants pending awarded to his institution from Merck & Co, Inc, and serving on the scientific advisory board for Merck & Co, Inc, ViiV Healthcare, Gilead Sciences, Inc, Shionogi, and Janssen Pharmaceuticals. D. L. reports receiving consulting fees from Theratechnologies and EMD Serono and stock ownership in Gilead Sciences. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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