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J Antimicrob Chemother. 2018 Aug 1;73(8):2177-2185. doi: 10.1093/jac/dky145.

Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors.

Author information

1
Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA 90095, USA.
2
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil.
3
Department of Medicine, The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, 6431 Fannin St., Houston, TX, USA.

Abstract

Background:

Obesity rates are increasing among HIV-infected individuals, but risk factors for obesity development on ART remain unclear.

Objectives:

In a cohort of HIV-infected adults in Rio de Janeiro, Brazil, we aimed to determine obesity rates before and after ART initiation and to analyse risk factors for obesity on ART.

Methods:

We retrospectively analysed data from individuals initiating ART between 2000 and 2015. BMI was calculated at baseline (time of ART initiation). Participants who were non-obese at baseline and had ≥90 days of ART exposure were followed until the development of obesity or the end of follow-up. Obesity incidence rates were estimated using Poisson regression models and risk factors were assessed using Cox regression models.

Results:

Of participants analysed at baseline (n = 1794), 61.3% were male, 48.3% were white and 7.9% were obese. Among participants followed longitudinally (n = 1567), 66.2% primarily used an NNRTI, 32.9% a PI and 0.9% an integrase strand transfer inhibitor (INSTI); 18.3% developed obesity and obesity incidence was 37.4 per 1000 person-years. In multivariable analysis, the greatest risk factor for developing obesity was the use of an INSTI as the primary ART core drug (adjusted HR 7.12, P < 0.0001); other risk factors included younger age, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, hypertension and diabetes mellitus.

Conclusions:

Obesity following ART initiation is frequent among HIV-infected adults. Key risk factors include female sex, HIV disease severity and INSTI use. Further research regarding the association between INSTIs and the development of obesity is needed.

PMID:
29722811
PMCID:
PMC6054231
DOI:
10.1093/jac/dky145
[Indexed for MEDLINE]
Free PMC Article

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