Dr. Christian Marsolais reports

THERATECHNOLOGIES CROI PRESENTATION HIGHLIGHTS LIMITATIONS OF USING BMI TO ASSESS CARDIOVASCULAR (CV) RISK IN PEOPLE WITH HIV

Theratechnologies Inc. has presented data highlighting the limitations of using body mass index (BMI) alone in assessing cardiovascular (CV) risk in people with HIV (PWH). The study underscores the need to incorporate screening for excess visceral abdominal fat (EVAF) to better identify PWH at risk of CV disease.

In a poster presentation at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, Calif., investigators from the visceral adiposity measurement and observation study (Vamos) characterized BMI as a poor independent surrogate for excess visceral adiposity and CV risk in PWH, particularly given the high CV risk observed in study participants with a normal or overweight BMI (low BMI) but high levels of EVAF. The investigators previously reported that EVAF is one of several risk factors that contribute to heightened CV risk in PWH who are on modern anti-retroviral therapy (ART) regimens.

"There is abundant evidence of substantial weight gain and a high prevalence of obesity among people with HIV in the modern anti-retroviral era," commented lead Vamos investigator Dr. Karam C. Mounzer, MD, chief scientific officer at Philadelphia Fight Community Health Centers in Philadelphia, Penn. "Clinicians routinely use BMI as a marker to assess the risk of cardiovascular disease and other co-morbidities in this population but often overlook the importance of identifying excess visceral abdominal fat, or EVAF. Our findings not only suggest that relying solely on BMI underestimates cardiovascular risk but show a high prevalence of EVAF among patients with normal BMI, which is an actual driver of such risk in people with HIV that many clinicians fail to capture in their clinics."

Vamos is a cross-sectional, multicentre, observational study investigating the relationships between BMI, EVAF (defined as a visceral adipose tissue (VAT) surface area greater than or equal to 130 square centimetres) and CV risk factors in 170 PWH who had attained virological suppression on ART for at least one year. The investigators compared 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores across four distinct groups:

• Low BMI (20 to 29 kilograms per square metre) without EVAF (VAT less than 130 square centimetres) (n equal to 62);
• Low BMI with EVAF (VAT greater than 130 square centimetres) (n equal to 52);
• High BMI (30 to 40 kilograms per square metre) without EVAF (n equal to 10);
• High BMI with EVAF (n equal to 46).

Unsurprisingly, obese individuals (BMI of 30 to 34.9 kilograms per square metre) had the highest prevalence of EVAF (88 per cent) in the study, followed by Class II obese PWH (BMI of 35 to 40 kilograms per square metre; 69 per cent). However, EVAF was still present in a substantial portion of PWH with normal BMI (20 to 25 kilograms per square metre; 43 per cent) and those classified as overweight (BMI 25 to 29.9 kilograms per square metre; 47 per cent).

Notably, PWH with EVAF had higher 10-year ASCVD risk scores than those without EVAF, irrespective of BMI (p equal to 0.0019). Additionally, high levels of pericardial fat volume (PFV, fat within the heart muscle) were found predominantly in participants with high EVAF, compared with those with low EVAF levels (p less than 0.0001). In a related finding, VAT area was more strongly correlated with PFV (Spearman r value equal to 0.73; p less than 0.0001) than with subcutaneous fat area (Spearman r equal to 0.2; p equal to 0.0109).

"In addition to providing a predictive estimate of cardiovascular risk, the Vamos findings show a substantial, real-time impact of fat in the body, as evidenced by the levels of pericardial fat volume," noted Dr. Christian Marsolais, PhD, senior vice-president and chief medical officer of Theratechnologies. "The results also underscore that, if health care providers focus solely on BMI, a sizable population of normal-weight and overweight individuals with HIV and EVAF will be missed. We hope this study encourages the use of simple and more precise tools for assessing EVAF, such as measuring waist circumference, as a proven means of identifying people with HIV who are at risk of cardiovascular disease."

About Theratechnologies Inc.

Theratechnologies is a specialty biopharmaceutical company focused on the commercialization of innovative therapies that have the potential to redefine standards of care.

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