HIV infection and obesity: where did all the wasting go?

Antivir Ther. 2012;17(7):1281-9. doi: 10.3851/IMP2348. Epub 2012 Sep 5.

Abstract

Background: The success of antiretroviral therapy (ART) has led to dramatic changes in causes of morbidity and mortality in HIV-infected individuals. As chronic diseases rates have increased in HIV+ populations, modifiable risk factors such as obesity have increased in importance. Our objective was to evaluate factors associated with weight change among patients receiving ART.

Methods: ART-naïve patients initiating therapy at the University of Alabama - Birmingham 1917 HIV/AIDS Clinic from 2000- 2008 were included. Body Mass Index (BMI) was categorized as: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9) and obese (≥30). Linear regression models were used to evaluate overall change in BMI and factors associated with increased BMI category 24 months following ART initiation.

Results: Among 681 patients, the mean baseline BMI was 25.4 ± 6.1; 44% of patients were overweight/obese. At 24 months, 20% of patients moved from normal to overweight/obese or overweight to obese BMI categories. Greater increases in BMI were observed in patients with baseline CD4 count < 50 cells/µl (3.4 ± 4.1, P<0.01) and boosted protease inhibitor use (2.5±4.1 P=0.01), but did not account for all of the variation observed in weight change.

Conclusions: The findings that almost half of patients were overweight or obese at ART initiation, and 1 in 5 patients moved to a deleterious BMI category within 2 years of ART initiation are alarming. ART therapy provides only a modest contribution to weight gain in patients. Obesity represents a highly prevalent condition in patients with HIV infection and an important target for intervention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • CD4 Lymphocyte Count
  • Female
  • Follow-Up Studies
  • HIV / genetics
  • HIV / pathogenicity
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / pathology
  • HIV Protease Inhibitors / adverse effects*
  • HIV Protease Inhibitors / therapeutic use
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Obesity / chemically induced*
  • Obesity / epidemiology
  • Overweight / chemically induced
  • Overweight / epidemiology
  • Prevalence
  • RNA, Viral / blood
  • Risk Factors
  • Time Factors

Substances

  • HIV Protease Inhibitors
  • RNA, Viral