Determinants of Weight Evolution Among HIV-Positive Patients Initiating Antiretroviral Treatment in Low-Resource Settings

Abstract

Background In resource limited settings clinical parameters, including body weight changes, are used to monitor clinical response. Therefore we studied body weight changes in patients on antiretroviral treatment (ART) in different regions of the world. Methods Data were extracted from the “International Epidemiologic Databases to Evaluate AIDS”, a network of ART programmes that prospectively collects routine clinical data. Adults on ART from the Southern-, East-, West- and Central African and the Asia-Pacific regions were selected from the database if baseline data on body weight, gender, ART regimen and CD4 count were available. Body weight change over the first two years and the probability of body weight loss in the second year were modelled using linear mixed models and logistic regression respectively. Results Data from 205,571 patients were analysed. Mean adjusted body weight change in the first 12 months was higher in patients started on tenofovir and/or efavirenz; in patients from Central, West and East Africa, in men, and in patients with a poorer clinical status. In the second year of ART it was greater in patients initiated on tenofovir and/or nevirapine, and for patients not on stavudine, in women, in Southern Africa and in patients with a better clinical status at initiation. Stavudine in the initial regimen was associated with a lower mean adjusted body weight change and with weight loss in the second treatment year. Conclusion Different ART regimens have different effects on body weight change. Body weight loss after one year of treatment in patients on stavudine might be associated with lipoatrophy.

Body mass index variation over time and associated factors among HIV-positive adults on second-line ART in north-west Ethiopia: a retrospective follow-up study

“…When compared with patients at WHO stage I, those at WHO stages III and IV have decreased BMI. This finding is in line with a multicentre study in resource-limited settings which shows individuals who had high clinical status (WHO stages III and IV) had poorer weight gain when compared with weight change in patients at lower WHO stage 14. The possible reason can be unexplained chronic diarrhoea and HIV enteropathy in these patients and the associated malabsorption4 or it could be due to fever of unknown origin in the late stage of the disease which results in an increased calorie loss and wasting 30…”

“…The BMI of patients with HIV is affected by gender,14 duration of treatment,10 15 16 isoniazid prophylaxis therapy (IPT) and cotrimoxazole prophylaxis therapy (CPT),17 18 WHO stage14 and CD4 count 15 19…”

Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study

“…Additionally, more frequent contact with the health care system due to chronic HIV care may provide opportunities for reinforcement of health care messages on the importance of maintaining a healthy weight [40]. Finally, different antiretroviral therapies may also have differing effects on weight [41]. Lower BMI with problematic alcohol consumption may be due to the chronic malnutrition that can occur with excess alcohol intake [42].…”

Metabolic Profiles of Individuals Switched to Second-Line Antiretroviral Therapy after Failing Standard First-Line Therapy for Treatment of HIV-1 Infection in a Randomized, Controlled Trial

“…Confusing the interpretation is the fact that lipid changes may not be a direct consequence of ART but rather signify a return to health induced by successful ART and associated weight gain, with increase in body fat driving metabolic changes as found in the general population. This is supported by studies indicating that weight increase is correlated with increased CD4 count (3). A recent dual energy X-ray absorptiometry (DXA) -scan substudy of ACTG 5257 showed that darunavir/ritonavir (DRV/r), atazanavir/ritonavir (ATV/r) and raltegravir (RAL) (all combined with tenofovir [TDF]/ emtricitabine [FTC]) were associated with the same degree of visceral fat accumulation (4).…”