HIV Infection and Obesity: Where Did All the Wasting Go?

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 disease rates have increased in HIV-positive 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-naive patients initiating therapy at the University of Alabama, Birmingham 1917 HIV/AIDS Clinic from 2000 to 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 from overweight to obese BMI categories. Greater increases in BMI were observed in patients with baseline CD4⁺ T-cell counts <50 cells/μl (3.4 ±4.1; P<0.01) and in those on boosted protease inhibitors (2.5 ±4.1; P=0.01), but did not account for all of the variations observed in weight change.

Conclusions

The findings that almost one-half of patients were overweight or obese at ART initiation and that 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.

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