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Original article

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

Tyler Tate, Amanda L Willig, James H Willig, James L Raper, Linda Moneyham, Mirjam-Colette Kempf, Michael S Saag, Michael J Mugavero

Corresponding author name: Amanda L Willig
Corresponding author e-mail: mandyrd@uab.edu

Citation: Antiviral Therapy 2012; 17:1281-1289
doi: 10.3851/IMP2348

Date accepted: 04 March 2012
Date published online: 05 September 2012

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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