LAUSR

BACKGROUND Little is known regarding the long-term effects of antiretroviral (ARV) exposure on body composition for people living with HIV (PLWH) since early childhood. This study explores changes in body fat distribution in relation to ARV exposure. METHODS We conducted a prospective study of adults with perinatal HIV (n=70) using dual energy X-ray absorptiometry and standard anthropometrics. Trunk-limb fat ratio and waist-hip ratio were compared cross-sectionally to 47 matched controls. Further, changes in body composition and ARV exposure were evaluated longitudinally in a subset of 40 PLWH with a median follow-up of 7 years. RESULTS Cross-sectional comparisons of PLWH to controls revealed significantly higher waist-hip ratio, trunk-limb fat ratio, HOMA-IR, and triglycerides, whereas BMI did not differ. Among PLWH with longitudinal follow-up, the prevalence of overweight increased (27.5% to 52.5%) as did obesity (12.5% to 25%); waist-hip and trunk-limb fat ratios also increased (p<.0001). Changes in waist-hip ratio were positively correlated with longer exposure during follow-up to darunavir (r=0.36; p=.02); whereas, increases in trunk-limb fat ratio were positively correlated with longer exposure to stavudine (r=0.39; p=.01) and didanosine (r=0.39; p=.01), but inversely associated with emtricitabine (r=-0.33; p=.04). Increases in waist-hip ratio were correlated with increases in triglyceride levels (r=0.35; p=.03). CONCLUSION This study presents strong evidence for persistent and worsening central adiposity in young adults with life-long HIV and extensive ARV exposure. As this cohort ages, continued evaluation of the body composition and metabolic impact of life-long ARV therapy is warranted to optimize long-term health.