Male sex and obesity are associated with residual plasma HIV-1 viremia in persons on long-term antiretroviral therapy

Background: Although adipose tissue has been proposed to harbor part of the HIV-1 reservoir, the influence of host characteristics, including sex and body-mass index (BMI), on measures of HIV-1 persistence during ART are incompletely understood.

Methods: We evaluated age, sex, BMI, waist circumference, years on ART, pre-ART HIV-1 RNA, pre-ART CD4+ T cell count, and initial ART regimen with measures of HIV-1 persistence in blood (residual viremia, cellular HIV-1 DNA and RNA) in a cohort of 295 individuals with well-documented long-term virologic suppression (HIV-1 RNA <50 copies/mL) on ART (AIDS Clinical Trial Group A5321).

Results: Males were more likely than females to have detectable plasma HIV-1 RNA by single copy assay (52% vs 29%, p=0.003), and the proportion of participants with detectable residual viremia increased in a stepwise fashion by BMI category: normal/underweight 38%; overweight 50%; obese 55%. ART regimen type was not associated with measures of HIV-1 persistence after controlling for ART duration.

Conclusions: Sex and obesity are independently associated with residual viremia in people on long-term ART. Additional studies to confirm these relationships and to define the mechanisms by which sex and obesity affect HIV-1 persistence are needed to inform HIV-1 cure strategies.

Keywords: HIV-1; obesity; sex.