Anthropometric characteristics and changes with HIV and ART in a randomly selected population in the Drakenstein region Western Cape Province

Beukes, Dillan Charles (2014-12)

Thesis (MSc)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Background - Highly active antiretroviral therapy (HAART) has extended life expectancy and enhanced the well-being of HIVpositive individuals. Since there are concerns regarding HAART-mediated onset of cardio-metabolic diseases in the long-term, we evaluated the anthropometric profile of HIV-infected individuals in the Drakenstein District (Western Cape, South Africa). - Objective of study - The primary objective of this study was to document the anthropometric characteristics within and HIV infected population in the Drakenstein region of the Western Cape Province of South Africa. - Methods - HIV-positive patients (n=44 males, n=102 females; 20-40 yrs.) were recruited for three groups: 1) control (HIVnaïve), 2) HIV-positive (HAART ≤ 0-36 months), and 3) HIV-positive (HAART ≥ 36 months). Participants underwent a) anthropometric (triceps skin fold [TSF], and b) bioelectrical impedance measurements (body cell mass [BCM], fat free mass [FFM], protein, muscle mass (MM), mineral, total body potassium (TBK) and calcium (TBCa), glycogen, and fat mass [FM]). - Results - Our data reveal that HIV-positive males on HAART ≤ 0-36 months displayed a trend for lower body cell mass (BCM), fat free mass (FFM), fat mass (FM), triceps skinfold (TSF) and protein content (vs. control). Females exhibited reduced BCM (p=0.001) and lower protein (p=0.003), muscle mass (p=0.001), glycogen (p=0.001), FM (p=0.0005) and FFM (p=0.002) content. However, with longer-term treatment (HAART ≥ 36 months), females displayed higher BCM (p=0.0001), protein (p=0.01), muscle mass (p=0.0003), glycogen (p=0.0001), FM (p=0.00003) and FFM (p=0.0002) vs. the 0-36 months treatment group. Their waist-to-hip ratio also increased vs. the naïve female group (p=0.02). By contrast, males on HAART ≥ 36 months did not show any significant increases vs. the HAART ≤ 0-36 month’s group. - Conclusions - This study demonstrates observed striking gender-based anthropometric differences in South African HIVpositive individuals on HAART. While both genders initially exhibit muscle wasting, HIV-positive females show a strong improvement with longer-term treatment vs. males. However, higher abdominal fat accumulation in females with longer-term treatment potentially increases their risk for the future onset of cardio-metabolic complications.

AFRIKAANSE OPSOMMING: Agtergrond - Hoogs-aktiewe anti-retrovirale terapie (HAART) het beide die lewensverwagting en lewenskwaliteit van MIVpositiewe individue verhoog. Omrede daar kommer uitgepsreek is oor die HAART gemedieerde aanvang van kardio-metaboliese siekte oor die langtermyn, het ons die antropometriese profile van MIV geïnfekteerde individue in die Drakenstein Distrik (Wes-Kaap Provinsie, Suid Afrika) ondersoek. - Doel van die studie - Die primêre doel van die studie was om die antropometriese eienskappe van ‘n MIV-geïnfekteerde populasie in die Drakenstein omgewing van die Wes-Kaap Provinsie van Suid Afrika te ondersoek. Daar is ook verder gepoog om die verwantskap hiermee met die risiko vir kardiometaboliese siekte te probeer vastel. - Metodes - MIV-positiewe pasiënte (n=44 mans, n=102 vroue; 20-40 jr.) is gewerf in drie groepe: 1) kontrole (HIV-naïef), 2) MIV-positief (HAART ≤ 0-36 maande), en 3) MIV-positiewe (HAART ≥ 36 maande). Deelnemers het a) antropometriese evaluering ondergaan (trisepsvelvou [TVV], en b) bio-elektriese impedansie metings (liggaamselmassa [LSM], vetvrye massa [VVM], proteïen, spiermassa (SM), minerale, totale liggaamkalium (TLK), en kalsium (TLCa), glikogeen, en vetmassa [VM]). - Resultate - Ons data toon aan dat MIV-positiewe mans op HAART ≤ 0-36 maande ‘n laer neiging tot LSM, VVM, VM, TVV en proteïeninhoud het vergeleke met die kontrole. Vroue het ‘n verlaagde LSM opgelewer (p=0.001) sowel laer proteïen (p=0.003), spiermassa (p=0.001), glikogeen (p=0.001), VM (p=0.0005) en VVM (p=0.002). Hoewel, met lang-termyn behandeling (HAART ≥ 36 maande), het vroue ‘n hoër LSM (p=0.0001), proteïen (p=0.01), spiermassa (p=0.0003), glikogeen (p=0.0001), VM (p=0.00003) en VVM (p=0.0002) opgelewer vs. die 0-36 maande behandelingsgroep. Hulle middel:heup verhouding het ook betekenisvol verhoog vs. die kontrole vroue groep (p=0.02). Kontrasterend het die mans op HAART ≥ 36 maande geen betekenisvolle toenames vs. die HAART ≤ 0-36 maande groep opgelewer nie. - Gevolgtrekking - Hierdie studie demonstreer treffende geslagsgebaseerde antropometriese verskille in n Suid Afrikaanse HIVpositiewe populasie wat op HAART is. Terwyl beide geslagte aanvanglik spierwegkwyning vertoon het, het die MIV positiewe vroue ‘n goeie verbetering met lang-termyn behandeling vs die mans opgelewer. Alhoewel daar hoër abdominale vetophoping in die vroue waargeneem is wat op langtermynbehandeling is, kan dit hulle risiko vir toekomistige aanvang van kardio-metaboliese siekte komplikasies verhoog.

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