Does BMI Reliably Address Cardiovascular Risk in People with HIV?

People with HIV (PWH) living in the modern antiretroviral therapy (ART) era, many of whom are now over the age of 50 years, may experience weight gain and excess visceral abdominal fat (EVAF), which are all linked to increased cardiovascular disease (CVD) risk. While BMI is proposed as a means to gauge CVD risk, this may not be appropriate in PWH who have EVAF. Previous analysis of data from the Visceral Adiposity Measurement and Observations Study (VAMOS), which included 170 PWH taking ART with a BMI between 20−40 kg/m2, revealed a relationship between EVAF and both the overall and components of the America College of Cardiology (ACC)/American Heart Association (AHA) 10-year atherosclerotic CVD (ASCVD) risk score. In this poster presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2025, nearly half of the participants with a ‘normal’ (20−25 kg/m2) or ‘overweight’ (25−29 kg/m2) BMI had EVAF (visceral adipose tissue [VAT] surface area ≥130 cm2), as measured by CT scan. The vast majority of participants with BMI 30−40 kg/m2 also had EVAF. ASCVD risk score level was significantly higher in participants with ‘high’ EVAF compared to low EVAF (VAT surface area