Tecla M Temu 1 , Jessica Wagoner, Sarah Masyuko, Aidan O'Connor, Jerry S Zifodya, Paul Macharia, Celestine N Wanjalla, Jerusha N Mogaka, Bhavna Chohan, Victor M Omodi, Ana L Gervassi, Julius Oyugi, Stephanie T Page, Carey Farquhar, Stephen J Polyak
, Temu TM, Wagoner J, Masyuko S, O'Connor A, Zifodya JS, Macharia P, Wanjalla CN, Mogaka JN, Chohan B, Omodi VM, Gervassi AL. Central obesity is a contributor to systemic inflammation and monocyte activation in virally suppressed adults with chronic HIV in Kenya. AIDS (London, England). 2021 May 24.
Objectives: Heightened systemic inflammation is common in obese individuals and persons with HIV (PWH) and is independently associated with an increased risk of cardiovascular diseases (CVD). We investigated the combined effect of central obesity, a surrogate measure of visceral fat, and HIV on circulating levels of inflammatory cytokines among Kenyan adults.
Design: Cross-sectional study.
Methods: We analyzed and compared data from 287 virally suppressed PWH and 277 non-infected Kenyan adults including biomarkers of gut epithelial dysfunction (intestinal fatty acid binding protein), monocyte activation (soluble CD163 and CD14), and inflammation (interleukin [IL]-1β, IL-6, TNF-α, and hsCRP) by HIV/central obesity status (HIV+/obese, HIV-/obese, HIV+/non-obese, and HIV-/non-obese). Central obesity was defined as waist circumference >80 cm for women and >94 cm for men. We assessed the association of HIV/obesity status with elevated biomarkers (>75th percentile) using logistic regression.
Results: Median age for participants was 44 years and 37% were centrally obese. Levels of all biomarkers were higher among the HIV+/obese compared to the HIV-/non-obese (p < 0.05 for all comparisons). The HIV+/obese group had the greatest odds of having elevated inflammatory biomarkers compared to other groups even after adjustment of age, BMI, and other conventional CVD risk factors (p < 0.05 for all). Additional adjustment for sCD163 in the multivariate model substantially attenuated the association for HIV+/obesity with IL-1β, IL-6, and TNF-α but not hsCRP. The contribution of HIV+/obesity to inflammation was independent of the degree of immunosuppression.
Conclusions: Central obesity is prevalent among virally suppressed African PWH and is associated with greater inflammation and monocyte activation independent of other comorbidities and HIV-specific factors.