Evaluation Of Body Composition Of DXA In Male Patients With HIV / AIDS Incomplete Immune Response And Muscle Loss

Objective To assess whether baseline body composition and other clinical factors were associated with incomplete immune response after highly active antiretroviral therapy (HAART) in Chinese HIV-infected men.Methods A retrospective study was conducted among HIV-infected men after a year of HAART between 2007 and 2015. Clinical, immunological, virological data were collected from patients’files, including weight, height and whole body composition measured within one month prior to staring HAART. Body mass index (BMI), lean mass index(LMI), fat mass index(FMI) and body bone mineral content/height ratio were adjusted by height. According to whether the patients appears incomplete immune responses(CD4 count<350 cells/μl) after a year of HAART, the patients were devided into two groups, the complete immune response(≥350 cells/μl)and the incomplete immune response(<350 cells/μl), respectively. Student’s t test, chi-square test, Wilcoxon rank test were used to assess differences between the two groups. Logistic regression analysis was used to assess factors associated with an incomplete immune response. ROC curve was used to evaluate the clinical efficiency of related factors.Results 84 male HIV-infected patients were included in this study. There were statistical differences between these two groups(P<0.05), including age, baseline BMI, total-body lean mass index, appendicular lean mass index, and CD4 count. However, there were no statistical difference(P>0.05)in viral load, total-body fat mass index, body bone mineral content/height ratio, HAART duration and HAART regimen. BMI (odds ratio 0.752,95% confidence interval 0.568-0.996; P=0.044), total-body lean mass index (odds ratio 0.432,95% confidence interval 0.215-0.870; P= 0.018), appendicular lean mass index (odds ratio 0.271, 95% confidence interval 0.082 -0.898; P= 0.032), HAART duration (odds ratio 0.072,95% confidence interval 0.009-0.557; P=0.011), baseline CD4 count (odds ratio 67.161,95% confidence interval 8.954-503.770; P <0.0001) were significantly associated with incomplete immune response. Age(odds ratio 1.352,95% confidence interval 0.159-11.484;P=0.782), viral load(odds ratio 0.303,95% confidence interval 0.058-1.579; P=0.156), fat mass index (odds ratio 0.883,95% confidence interval 0.722-1.079; P=0.223), body bone mineral content/height ratio (odds ratio 1.012,95% confidence interval 0.151-6.772;P=0.989) and HAART regimen (odds ratio 0.617,95% confidence interval 0.143-2.660;P=0.517) were not associated with incomplete immune response. The optimal cut-off value for baseline BMI was 21.9kg/m2, corresponding to a sensitivity of 63.3% and specificity of 67.9% in the ROC curve. The optimal cut-off value for baseline whole-body LMI was 16.8kg/m2, corresponding to a sensitivity of 77.6% and specificity of 67.9% in the ROC curve. The optimal cut-off value for baseline AMI was 7.6kg/m2,corresponding to a sensitivity of 75.5% and specificity of 60.7% in the ROC curve. There was significant difference in the area under the ROC curve between the baseline BMI and whole-body LMI (P=0.044).Conclusions Higher baseline LMI was less likely to have an incomplete immune response compared with lower baseline LMI. The predictive value of the whole-body LMI for incomplete immune response is better than baseline BMI. Baseline FMI and body bone mineral content/height ratio were not associated with incomplete immune response.Objective To investigate the characteristics of body composition in male HIV/AIDS adults, and to analyze the related factors of the low lean mass and the change of lean mass after HAART.Methods 72 male HIV/AIDS patients received HAART were selected. The clinical, immunological and viral data, including the data of body composition measured by DXA, were collected from patients’files. Referring to the literature, the appendicular lean mass index<7kg/m2 was diagnosed as low lean mass. Chi square test, t test and non parametric rank sum test were used to compare the difference of low lean mass and no low lean mass, and the difference of lean mass before and after HAART was compared. Logistic regression analysis was used to analyze the related factors of low lean mass and the change lean mass after HAART in male HIV/AIDS patients.Results In 72 male patients with HIV/AIDS,26 patients had low lean mass and 46 patients without low lean mass. Patients in the two groups differed significantly for baseline body weight, body mass index, appendicular lean mass, total-body lean mass, total-body lean mass index, total-body bone mineral content and total-body bone mineral content/height ratio, previous opportunistic infection history (P< 0.05).The two groups did not show significant differences in appendicular fat mass, trunk fat mass, total-body fat mass, total-body fat mass index, age, HIV infection duration, virus load, complicated with HBV/HCV or baseline CD4 + T cell count (P> 0.05). Logistic regression analysis showed that baseline body weight (OR = 0.805,95% confidence interval 0.716-0.905; P = 0.0003), body mass index (OR = 0.492,95% confidence interval 0.335-0.723; P = 0.0003), previous opportunistic infection (OR = 3.115,95% confidence interval 2.634-193.103; P=0.004) were correlated with low lean mass. Age, HIV infection duration, viral load, baseline CD4+T cell count, and HBV/HCV were not correlated with low lean mass (>0.05 P). Compared with the baseline level, the appendicular lean index (P,=0.04 t=-2.07) and the total-body lean index (t=-2.327,=0.019 P) were increased after 1 year of HAART. Logistic regression analysis showed that:baseline CD4+T cell count (OR 4.134,95% confidence interval 1.288-13.262;=0.017 P) was correlated with appendicular lean increase. Age, HIV infection, virus load, baseline CD4 + T cell count and increment of CD4 + T cells, previous opportunistic infections, complicated with HBV/HCV, baseline body weight and baseline body mass index, baseline appendicular lean mass, total-body lean mass, appendicular lean mass index, total-body lean mass index, total-body fat mass, body bone mineral content, body bone mineral content/height ratio, HAART duration or HAART regimens was not correlated with lean mass change (P> 0.05).Conclusions Baseline BMI was negatively associated with low lean mass in male HIV/AIDS patients, and a higher baseline BMI was associated with less risk of low lean mass. Previous opportunistic infection is a risk factor for low lean mass. Baseline CD4+T cell count was one predictive factor of increased lean mass after HAART. Patients with lower baseline CD4+ T count have a obvious increase in lean mass after HAART. No correlation between viral load and lean mass change.