Beyond Body Mass Index: The Importance of Excess Visceral Abdominal Fat in HIV Patients and Its Implications
On March 12, 2025, Theratechnologies Inc., a leading biopharmaceutical company, announced the presentation of data emphasizing the shortcomings of using Body Mass Index (BMI) as the sole indicator for assessing cardiovascular (CV) risk in people living with HIV (PWH). This study, which was not publicly accessible without subscription, highlighted the significance of screening for Excess Visceral Abdominal Fat (EVAF) to improve the identification of PWH at risk of CV disease.
The Limitations of Body Mass Index in HIV Patients
BMI, which is calculated by dividing an individual’s weight in kilograms by the square of their height in meters, has long been used as a standard measure of body fat. However, it fails to distinguish between different types of body fat, such as subcutaneous fat and visceral fat. Visceral fat, which is located deep within the abdominal cavity and surrounds vital organs, is metabolically active and has been linked to a higher risk of CV disease, insulin resistance, and metabolic disorders.
In the context of HIV, the use of BMI as the sole indicator of CV risk can be misleading, as PWH often exhibit a unique body composition characterized by a redistribution of body fat, resulting in increased EVAF and decreased subcutaneous fat. This can lead to an underestimation of CV risk based on BMI alone.
The Role of Excess Visceral Abdominal Fat in HIV and Cardiovascular Disease
EVAF is a more accurate predictor of CV risk in PWH than BMI. The accumulation of EVAF is associated with an increased risk of CV disease, including coronary artery disease, stroke, and peripheral artery disease. This is due to the fact that EVAF is metabolically active and secretes various inflammatory cytokines and adipokines, which contribute to the development and progression of atherosclerosis.
Moreover, the presence of EVAF can also affect the efficacy of antiretroviral therapy (ART) in PWH. Studies have shown that the accumulation of EVAF is associated with decreased response to ART, increased HIV viral load, and increased inflammation. Therefore, the identification and management of EVAF in PWH is crucial for both CV health and HIV disease control.
Implications for Individuals Living with HIV
The implications of these findings for individuals living with HIV are significant. While BMI remains an important measure of overall health, it should not be the sole indicator of CV risk in this population. PWH should undergo regular assessments for EVAF, which can be measured through imaging techniques such as computed tomography (CT) scans or magnetic resonance imaging (MRI).
Lifestyle modifications, such as regular physical activity, a healthy diet, and stress management, can help reduce EVAF and improve CV health. Medications such as statins, which are commonly used to lower cholesterol levels, have also been shown to have additional benefits in reducing EVAF and improving insulin sensitivity in PWH.
Implications for the World
The implications of these findings extend beyond the individual level and have important public health implications. Given the high prevalence of HIV and the associated CV risk, the widespread adoption of EVAF screening and management strategies could significantly reduce the burden of CV disease in this population. This could lead to improved health outcomes, reduced healthcare costs, and increased productivity.
Moreover, the findings from this study underscore the importance of continuing research into the unique health needs of PWH and the development of targeted interventions to address their specific health challenges. This includes not only the identification and management of CV risk but also the optimization of ART and the exploration of new treatment modalities.
Conclusion
In conclusion, the limitations of using BMI alone in assessing CV risk in PWH highlight the importance of incorporating EVAF screening into clinical practice. This will enable more accurate identification of PWH at risk of CV disease and facilitate the implementation of targeted interventions to improve both CV health and HIV disease control. The implications of these findings extend beyond the individual level and have important public health implications, underscoring the need for continued research and investment in the unique health needs of PWH.
- BMI is an inadequate indicator of CV risk in PWH due to the unique body composition and distribution of body fat in this population.
- EVAF, which is metabolically active and located deep within the abdominal cavity, is a more accurate predictor of CV risk in PWH.
- Regular EVAF assessments and lifestyle modifications can help reduce EVAF and improve CV health in PWH.
- Widespread adoption of EVAF screening and management strategies could significantly reduce the burden of CV disease in the HIV population.
