jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2026-18-2-42-52jofin-1987Research ArticleОБЗОРREVIEWСаркопения у людей, живущих с ВИЧ: патогенез, диагностика, направления клинической стратификации и терапии (обзор литературы)Sarcopenia in people living with HIV: pathogenesis, diagnosis, clinical stratification and therapy (literature review)ХохловаЗ. А.KhokhlovaZ. A.

Хохлова Зинаида Александровна – заведующий кафедрой инфекционных болезней Новокузнецкого государственного института усовершенствования врачей – филиала РМАНПО; профессор кафедры эпидемиологии и инфекционных болезней Кемеровского государственного медицинского университета, д.м.н., профессор

Новокузнецк, Кемерово; тел.: +7-913-318-97-03

Novokuznetsk, Kemerovo

zinaidaxoxlowa@yandex.ruСелинИ. И.SelinI. I.

Селин Илья Игоревич – ассистент кафедры эпидемиологии и инфекционных болезней.

Кемерово; тел.: +7-996-411-08-01

Kemerovo

kai1999@bk.ruНовокузнецкий государственный институт усовершенствования врачей – филиал Российской медицинской академии непрерывного профессионального образования; Кемеровский государственный медицинский университетРоссияNovokuznetsk State Institute for Advanced Medical Studies – the branch office of Russian Medical Academy of Continuous Professional Education; Kemerovo State Medical UniversityRussian FederationКемеровский государственный медицинский университетРоссияKemerovo State Medical UniversityRussian Federation2026200620261824252Copyright © Хохлова З.А., Селин И.И., 20262026Хохлова З.А., Селин И.И.Khokhlova Z.A., Selin I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1987

Саркопения у людей, живущих с вирусом иммунодефицита человека, постепенно приобретает самостоятельное клиническое значение на фоне увеличения продолжительности жизни и старения пациентских когорт. В обзоре рассматриваются распространённость и факторы риска снижения мышечной массы и силы у людей, инфицированных вирусом иммунодефицита человека, включая влияние хронической иммуноактивации, метаболических нарушений, сопутствующей патологии и антиретровирусной терапии. Обобщены данные о роли воспаления, миостеатоза, кинуренинового пути, нарушений костно-мышечной оси и факторов внешней среды. Отдельное внимание уделено действующим диагностическим подходам, адаптации логики Европейской группы по саркопении у пожилых второго пересмотра, с учётом характерных особенностей фенотипов, ассоциированных с вирусом иммунодефицита человека. Приведены сведения о клинических проявлениях саркопенического ожирения, остеосаркопении и сочетания саркопении с хрупкостью. Анализируются современные методы коррекции: тренировочные программы, нутритивные вмешательства, организационные модели ведения и возможные фармакологические подходы. Представлены данные, отражающие актуальные задачи для российской клинической практики.

Sarcopenia in people living with the human immunodeficiency virus is gradually gaining clinical significance in its own right against the background of increasing life expectancy and aging patient chores. The review examines the prevalence and risk factors for decreased muscle mass and strength in people infected with the human immunodeficiency virus, including the impact of chronic immunoactivation, metabolic disorders, comorbidities, and antiretroviral therapy. data on the role of inflammation, myosteatosis, kynurenin pathway, musculoskeletal axis disorders and environmental factors. Special attention is paid to the current diagnostic approaches, adaptation of the logic of the European Group on Sarcopenia in the Elderly of the second revision, taking into account the characteristic features of phenotypes associated with the human immunodeficiency virus. Information on clinical manifestations of sarcopenic obesity, osteosarcopenia and the combination of sarcopenia with fragility are given. Modern methods of correction are analyzed: training programs, nutritional interventions, organizational management models and possible pharmacological approaches. The data reflecting the current tasks for Russian clinical practice are presented.

мышечная массахрупкостьмиостеатозхроническое воспалениеEWGSOP2саркопеническое ожирениеsarcopeniaHIV infectionmuscle massfrailtymyosteatosischronic inflammationEWGSOP2sarcopenic obesityReferencesЛадная Н. Н. Эпидемическая ситуация по инфекции, вызываемой ВИЧ, в России в 2024 г. / Н. Н. Ладная, В. В. Покровский // Эпидемиология и инфекционные болезни. Актуальные вопросы. – 2025. – Т. 15, № 3. – С. 13–18. – DOI: 10.18565/epidem.2025.15.3.13-18. – EDN ZINEVW.Ladnaya NN, Pokrovskiy VV. Epidemicheskaya situatsiya po infektsii, vyzyvaemoy VICh, v Rossii v 2024 g. Epidemiologiya i Infektsionnye Bolezni. Aktual’nye Voprosy. 2025;15(3):13–18. DOI:10.18565/epidem.2025.15.3.13-18. EDN: ZINEVW. [in Russian].Jones H. T. et al. What problems associated with ageing are seen in a specialist service for older people living with HIV? // HIV Medicine. – 2022. – Т. 23. – № 3. – С. 259–267.Jones HT, et al. What problems associated with ageing are seen in a specialist service for older people living with HIV? HIV Med. 2022;23(3):259–67.Rees H. C. et al. HIV-related frailty is not characterized by sarcopenia // Journal of the International Association of Providers of AIDS Care (JIAPAC). – 2016. – Т. 15. – № 2. – С. 131–134.Rees HC, et al. HIV-related frailty is not characterized by sarcopenia. J Int Assoc Provid AIDS Care. 2016;15(2):131–4.SeyedAlinaghi S. A. et al. A systematic review of sarcopenia prevalence and associated factors in people living with human immunodeficiency virus // Journal of Cachexia, Sarcopenia and Muscle. – 2023. – Т. 14. – № 3. – С. 1168–1182.SeyedAlinaghi SA, et al. A systematic review of sarcopenia prevalence and associated factors in people living with human immunodeficiency virus. J Cachexia Sarcopenia Muscle. 2023;14(3):1168–82.Langkilde A. et al. Leptin, IL-6, and suPAR reflect distinct inflammatory changes associated with adiposity, lipodystrophy and low muscle mass in HIV-infected patients and controls // Immunity & Ageing. – 2015. – Т. 12. – № 1. – С. 9.Langkilde A, et al. Leptin, IL-6 and suPAR reflect distinct inflammatory changes associated with adiposity, lipodystrophy and low muscle mass in HIV-infected patients and controls. Immunity Ageing. 2015;12:9.Oursler K. K. et al. Telehealth exercise intervention in older adults with HIV: protocol of a multisite randomized trial // Journal of the Association of Nurses in AIDS Care. – 2022. – Т. 33. – № 2. – С. 168–177.Oursler KK, et al. Telehealth exercise intervention in older adults with HIV: protocol of a multisite randomized trial. J Assoc Nurses AIDS Care. 2022;33(2):168–77.Jankowski C. M. et al. Body composition changes in response to moderateor high-intensity exercise among older adults with or without HIV infection // JAIDS. – 2020. – Т. 85. – № 3. – С. 340–345.Jankowski CM, et al. Body composition changes in response to moderateor high-intensity exercise among older adults with or without HIV infection. J Acquir Immune Defic Syndr. 2020;85(3):340–5.Sultana S. et al. The kynurenine pathway in HIV, frailty and inflammaging //frontiers in Immunology. – 2023. – Т. 14. – С. 1244622.Sultana S, et al. The kynurenine pathway in HIV, frailty and inflammaging. Front Immunol. 2023;14:1244622.Oursler K. K. et al. Low muscle mass is associated with osteoporosis in older adults living with HIV // AIDS Research and Human Retroviruses. – 2020. – Т. 36. – № 4. – С. 300–302.Oursler KK, et al. Low muscle mass is associated with osteoporosis in older adults living with HIV. AIDS Res Hum Retroviruses. 2020;36(4):300–2.Ghayomzadeh M. et al. Combined training improves the diagnostic measures of sarcopenia and decreases the inflammation in HIV-infected individuals // Journal of Cachexia, Sarcopenia and Muscle. – 2022. – Т. 13. – № 2. – С. 1024–1035.Ghayomzadeh M, et al. Combined training improves diagnostic measures of sarcopenia and decreases inflammation in HIV-infected individuals. J Cachexia Sarcopenia Muscle. 2022;13(2):1024–35.Kehler D. S. et al. Frailty in older people living with HIV: current status and clinical management // BMC Geriatrics. – 2022. – Т. 22. – № 1. – С. 919.Kehler DS, et al. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr. 2022;22:919.Cárdenas J. D. G. et al. Statin protects men but not women with HIV against loss of muscle mass, strength, and physical function: a pilot study //scientific Reports. – 2023. – Т. 13. – № 1. – С. 4693.Cárdenas JDG, et al. Statin protects men but not women with HIV against loss of muscle mass, strength and physical function: a pilot study. Sci Rep. 2023;13:4693.Muhihi A. et al. Cholecalciferol supplementation does not affect the risk of HIV progression, viral suppression, comorbidities, weight loss, and depression among Tanzanian adults initiating antiretroviral therapy: secondary outcomes of a randomized trial // The Journal of Nutrition. – 2022. – Т. 152. – № 8. – С. 1983–1 990.Muhihi A, et al. Cholecalciferol supplementation does not affect the risk of HIV progression, viral suppression, comorbidities, weight loss or depression among Tanzanian adults initiating antiretroviral therapy. J Nutr. 2022;152(8):1983–90.Houssein M. et al. Frailty and sarcopenia among Turkish people aged 40 and above living with HIV // HIV Medicine. – 2022. – Т. 23. – № 10. – С. 1061–1068.Houssein M, et al. Frailty and sarcopenia among Turkish people aged 40 and above living with HIV. HIV Med. 2022;23(10):1061–8.Bonato M. et al. The role of physical activity for the management of sarcopenia in people living with HIV // IJERPH. – 2020. – Т. 17. – № 4. – С. 1283.Bonato M, et al. The role of physical activity for the management of sarcopenia in people living with HIV. Int J Environ Res Public Health. 2020;17(4):1283.Barbu E. C. et al. Body composition changes in men with HIV/HCV coinfection, HIV monoinfection, and HCV monoinfection // Acta Endocrinologica (Bucharest). – 2022. – Т. 18. – № 4. – С. 442.Barbu EC, et al. Body composition changes in men with HIV/HCV coinfection, HIV monoinfection and HCV monoinfection. Acta Endocrinol (Buchar). 2022;18(4):442–9.Martins L. C. et al. Prevalence and associated factors related to sarcopenia in people living with HIV/AIDS // BMC Infectious Diseases. – 2024. – Т. 24. – № 1. – С. 933.Martins LC, et al. Prevalence and associated factors related to sarcopenia in people living with HIV/AIDS. BMC Infect Dis. 2024;24:933.Gowda C. et al. Prevalence and predictors of low muscle mass in HIV/viral hepatitis coinfection // AIDS. – 2016. – Т. 30. – № 16. – С. 2519–2528.Gowda C, et al. Prevalence and predictors of low muscle mass in HIV/viral hepatitis coinfection. AIDS. 2016;30(16):2519–28.Deminice R. et al. Sarcopenia related to human immunodeficiency virus: protective effects of exercise // Exercise and Sport Sciences Reviews. – 2022. – Т. 50. – № 2. – С. 73–80.Deminice R, et al. Sarcopenia related to human immunodeficiency virus: protective effects of exercise. Exerc Sport Sci Rev. 2022;50(2):73–80.Debeaudrap P. et al. The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: the VIRAGE study // BMC Public Health. – 2024. – Т. 24. – № 1. – С. 1549.Debeaudrap P, et al. The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: the VIRAGE study. BMC Public Health. 2024;24:1549.Echeverría P. et al. High prevalence of sarcopenia in HIV-infected individuals // BioMed Research International. – 2018. – 2018:5074923.Echeverría P, et al. High prevalence of sarcopenia in HIV-infected individuals. Biomed Res Int. 2018;2018:5074923.Serrano-Villar S. et al. The CD4:CD8 ratio is associated with markers of age-associated disease in virally suppressed HIV-infected patients // HIV Medicine. – 2014. – Т. 15. – № 1. – С. 40–49.Serrano-Villar S, et al. The CD4:CD8 ratio is associated with markers of age-associated disease in virally suppressed HIV-infected patients. HIV Med. 2014;15(1):40–9.Currò M. et al. Vitamin D status modulates inflammatory response in HIV+ subjects: evidence for involvement of autophagy and TG2 expression in PBMC // International Journal of Molecular Sciences. – 2020. – Т. 21. – № 20. – С. 7558.Currò M, et al. Vitamin D status modulates inflammatory response in HIV+ subjects: evidence for involvement of autophagy and TG2 expression in PBMC. Int J Mol Sci. 2020;21(20):7558.Erlandson K. M. et al. Mitochondrial DNA haplogroups and frailty in adults living with HIV // AIDS Research and Human Retroviruses. – 2020. – Т. 36. – № 3. – С. 214–219.Erlandson KM, et al. Mitochondrial DNA haplogroups and frailty in adults living with HIV. AIDS Res Hum Retroviruses. 2020;36(3):214–9.Tibuakuu M. et al. Low thigh muscle mass is associated with coronary artery stenosis // Journal of Cardiovascular Computed Tomography. – 2018. – Т. 12. – № 2. – С. 131–138.Tibuakuu M, et al. Low thigh muscle mass is associated with coronary artery stenosis. J Cardiovasc Comput Tomogr. 2018;12(2):131–8.Konishi K. et al. Sarcopenia among PLWH and the effect of ART on body composition // Medicine. – 2022. – Т. 101. – № 42. – e31349.Konishi K, et al. Sarcopenia among PLWH and the effect of ART on body composition. Medicine (Baltimore). 2022;101(42):e31349.Dutta D. et al. Predictors of osteoporosis and body composition in asymptomatic pre-menopausal women with HIV // Indian J Med Res. – 2018. – Т. 147. – № 5. – С. 484–495.Dutta D, et al. Predictors of osteoporosis and body composition in asymptomatic pre-menopausal women with HIV. Indian J Med Res. 2018;147(5):484–95.Peng T. et al. Sarcopenia and association with HIV in China elderly // Medicine. – 2024. – Т. 103. – № 26. – e38532.Peng T, et al. Sarcopenia and association with HIV in the elderly population in China. Medicine (Baltimore). 2024;103(26):e38532.Wallet M. A. et al. Increased inflammation but similar body composition and function in older HIV-1 infected subjects // BMC Immunology. – 2015. – Т. 16. – № 1. – С. 43.Wallet MA, et al. Increased inflammation but similar body composition and function in older HIV-1 infected subjects. BMC Immunol. 2015;16:43.da Silva Paes L. et al. Effects of a 2-year supervised exercise program in HIV-infected patients // The Open AIDS Journal. – 2015. – Т. 9. – С. 80.Da Silva Paes L, et al. Effects of a 2-year supervised exercise program in HIV-infected patients. Open AIDS J. 2015;9:80–8.Ditzenberger G. L. et al. Non-invasive imaging of skeletal muscle quantity and quality in people with HIV: a narrative review // HIV Medicine. – 2023. – Т. 24. – № 12. – С. 1176–1189.Ditzenberger GL, Oliveira VHF, Jankowski CM, Erlandson KM. The use of non-invasive imaging modalities for the assessment of skeletal muscle quantity and quality in people with HIV: a narrative review. HIV Med. 2023;24(12):1176–89.Xu Y. et al. Factors associated with skeletal muscle mass in middle-aged men living with HIV // J Cachexia Sarcopenia Muscle. – 2024. – Т. 15. – № 5. – С. 1965–1975.Xu Y, et al. Factors associated with skeletal muscle mass in middle-aged men living with HIV. J Cachexia Sarcopenia Muscle. 2024;15(5):1965–75.Vieira L. C., Ximenez J. A., Spexoto M. C. B. SARCF vs SARC-CalF in PLWH // Clinics. – 2025. – Т. 80. – 100565.Vieira LC, Ximenez JA, Spexoto MCB. SARC-F vs SARCCalF in PLWH. Clinics (Sao Paulo). 2025;80:100565.Thet D. et al. Malnutrition and sarcopenia in elderly people living with HIV during the COVID-19 pandemic // Nutrients. – 2024. – Т. 16. – № 15. – 2540.Thet D, et al. Malnutrition and sarcopenia in elderly people living with HIV during the COVID-19 pandemic. Nutrients. 2024;16(15):2540.Milic J. et al. Sarcopenic obesity phenotypes in HIV and implications for cardiovascular prevention // Canadian Journal of Cardiology. – 2023. – Т. 39. – № 11. – S359–S367.Milic J, et al. Sarcopenic obesity phenotypes in HIV and implications for cardiovascular prevention. Can J Cardiol. 2023;39(11):S359–67.Chetty L., Cobbing S., Chetty V. Physical activity and exercise for older people living with HIV: a scoping review // HIV/AIDS – Research and Palliative Care. – 2021. – С. 1079–1090.Chetty L, Cobbing S, Chetty V. Physical activity and exercise for older people living with HIV: a scoping review. HIV AIDS (Auckl). 2021:1079–90.O’Brien K. K. et al. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol // BMC infectious diseases. – 2016. – Т. 16. – № 1. – С. 182.O’Brien KK, et al. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis. 2016;16:182.de Brito-Neto J. G. et al. Strength training improves body composition, muscle strength and increases CD4+ T lymphocyte levels in people living with HIV/AIDS // Infectious Disease Reports. – 2019. – Т. 11. – № 1. – С. 7925.De Brito-Neto JG, et al. Strength training improves body composition, muscle strength and increases CD4+ T lymphocyte levels in people living with HIV/AIDS. Infect Dis Rep. 2019;11(1):7925.Pérez Chaparro C. G. A. et al. Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV. A meta-analysis // PLOS One. – 2018. – Т. 13. – № 9. – С. e0203384.Pérez Chaparro CGA, et al. Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV: a meta-analysis. PLoS One. 2018;13(9):e0203384.Brañas F. et al. A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study //frontiers in Public Health. – 2024. – Т. 12. – С. 1373910.Brañas F, et al. A 12-week multicomponent exercise program enhances frailty, improves physical performance and preserves muscle mass in older adults with HIV: MOVIhNG study. Front Public Health. 2024;12:1373910.Хорошилов И. Е. Саркопения у больных: диагностика и перспективы лечения // Лечащий врач. – 2017. – № 8. – С. 36–36.Khoroshilov IE. Sarkopeniya u bol’nykh: diagnostika i perspektivy lecheniya. Lechashchiy Vrach. 2017;(8):36–36. [in Russian].Бондаренко А. И. Саркопения – характерный синдром ВИЧ-инфекции // Национальная ассоциация ученых. – 2021. – № 65–2. – С. 6–9.Bondarenko AI. Sarkopeniya – kharakternyy sindrom VICh-infektsii. Natsional’naya Assotsiatsiya Uchenykh. 2021;65(2):6–9. [in Russian].Бондаренко, А. И. Клинико-лабораторные проявления поражения скелетно-мышечной системы при ВИЧинфекции: специальность 14.01.09 «Инфекционные болезни»: диссертация на соискание ученой степени кандидата медицинских наук / А. И. Бондаренко. – Волгоград, 2021. – 139 с. – EDN PXIKVL.Bondarenko AI. Kliniko-laboratornyye proyavleniya porazheniya skeletno-myshechnoy sistemy pri VICh-infektsii [dissertation]. Volgograd; 2021. 139 p. EDN: PXIKVL. [in Russian].De Vincentis S. et al. Sarcopenic obesity and reduced BMD in young men with HIV: body composition and sex steroids interplay // J Endocrinol Invest. – 2024. – Т. 47. – № 11. – С. 2715–2730.De Vincentis S, et al. Sarcopenic obesity and reduced BMD in young men with HIV: body composition and sex steroid interplay. J Endocrinol Invest. 2024;47(11):2715–30.

The authors declare that there are no conflicts of interest present.