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Nutritional Epidemiology

HIV-1 Viral Load and Elevated Serum ₁-Antichymotrypsin Are Independent Predictors of Body Composition in Pregnant Zimbabwean Women

Henrik Friis^*,1, Exnevia Gomo^**, Norman Nyazema, Patricia Ndhlovu^**, Pernille Kæstel^*, Henrik Krarup and Kim F. Michaelsen^*

^* Research Department of Human Nutrition, Royal Veterinary and Agricultural University, Frederiksberg, Denmark; Danish Bilharziasis Laboratory, Charlottenlund, Denmark; ^** Blair Research Laboratory, Ministry of Health, Harare, Zimbabwe; Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe; and Department of Clinical Chemistry, Aalborg University Hospital, Aalborg, Denmark

¹To whom correspondence should be addressed. E-mail: h.friis{at}pubhealth.ku.dk.

Human immunodeficiency virus (HIV) infection affects body composition, but their relationship has not been studied in pregnant women. We conducted a cross-sectional study among 1669 women receiving antenatal care between 22 and 35 wk of gestation in Harare, Zimbabwe. The role of HIV-1 status and viral load, malaria and elevated serum ₁-antichymotrypsin (ACT, an acute phase protein) in weight, body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TSF), and arm muscle (AMA) and fat (AFA) area were assessed using multiple linear regression analysis. The mean (range) age was 24.4 (14–45) y and gestational age 29 (22–35) wk. HIV infection was present in 31.5% of the women, malaria parasitemia in 0.4% and 11.4% had serum ACT >0.4 g/L. There was no difference in any anthropometric variable between HIV-infected and uninfected women. However, women with viral loads (genome equivalents/mL) between 4 and 5 and >5 log₁₀ had 1.1 [95% confidence interval (CI): -0.3, 2.3] and 2.5 (95% CI: 0.1, 5.1) kg lower weights compared with uninfected women; this was explained by losses of both AFA and AMA. Malaria parasitemia was associated with 6 cm² (95% CI: 0.4; 11.8) or 25% lower AMA. Elevated serum ACT was a negative predictor of all anthropometric variables, i.e., levels between 0.3 and 0.4, 0.4 and 0.5 and >0.5 g/L were associated with 1, 2 and 6 kg lower mean body weights, respectively. Despite the limitations of a cross-sectional design, we conclude that arm fat and muscle areas, reflecting body fat and lean body mass, seem to be unaffected in the majority of HIV-infected pregnant women, but decline with increasing viral loads. The effects of viral load are not explained by elevated serum ACT, which is a strong independent predictor of all anthropometric variables.

KEY WORDS: • HIV-1 • malaria • acute phase • body composition • pregnancy

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