Drug use and other risk factors related to lower body mass index among HIV-infected individuals

Abstract

Malnutrition is associated with morbidity and mortality in HIV infected individuals. Little research has been conducted to identify the roles that clinical, illicit drug use and socioeconomic characteristics play in the nutritional status of HIV-infected patients. This cross-sectional analysis included 562 HIV-infected participants enrolled in the Nutrition for Healthy Living study conducted in Boston, MA and Providence, RI. The relationship between body mass index (BMI) and several covariates (type of drug use, demographic, and clinical characteristics) were examined using linear regression.Overall, drug users had a lower BMI than non-drug users. The BMI of cocaine users was 1.4 kg/ m 2 less than that of patients who did not use any drugs, after adjusting for other covariates (p= 0.02). The BMI of participants who were over the age of 55 years was 2.0 kg/m 2 less than that of patients under the age of 35, and BMI increased by 0.3 kg/m 2 with each 100 cells/mm 3 increase in CD4 count. HAART use, adherence to HAART, energy intake, AIDS status, hepatitis B and hepatitis C co-infections, cigarette smoking and depression were not associated with BMI in the final model.In conclusion, BMI was lower in drug users than non-drug users, and was lowest in cocaine users. BMI was also directly associated with CD4 count and inversely related to age more than 55 years old. HIV infected cocaine users may be at higher risk of developing malnutrition, suggesting the need for anticipatory nutritional support.

Prevalence and Correlates of Elevated Body Mass Index among HIV-Positive and HIV-Negative Women in the Women's Interagency HIV Study

“…The most robust predictor of lower BMI for all women was current hard drug use, which is supported by other investigations, independent of any correlation with smoking and alcohol. 7,38 One recent study among HIVþ individuals showed that drug users compared to non-drug users were more likely to have lower energy intake, an AIDS diagnosis, and lower adherence to ART use. 38 Other behavioral factors such as smoking and alcohol use were also associated with lower BMI among HIVþ women.…”

“…7,38 One recent study among HIVþ individuals showed that drug users compared to non-drug users were more likely to have lower energy intake, an AIDS diagnosis, and lower adherence to ART use. 38 Other behavioral factors such as smoking and alcohol use were also associated with lower BMI among HIVþ women. Smoking is a well-established correlate of lower BMI.…”

“…38,43 The association between HAART and lower BMI is likely explained by selective initiation of ART use among persons with more advanced HIV disease and thus lower BMI due to cachexia. However, another possible explanation for the association of HAART with lower BMI is that after initial gains in fat due to a restoration to health, longer duration of specific antiretroviral drugs (particularly stavudine and zidovudine, which were commonly used during the timeframe of our study) has been associated with lipoatrophy.…”

Associations of Cocaine Use and HIV Infection With the Intestinal Microbiota, Microbial Translocation, and Inflammation

“…Drug use, in particular cocaine use, has been shown to be associated with impaired nutritional status (Quach et al, 2008) as well as with an increased risk of HIV and hepatitis C infection (Howe et al, 2005;McQuillan et al, 2006). Cocaine use affects body composition, irrespective of diet and lifestyle choices, resulting in a lower percentage of body fat compared with non-drug users (Forrester et al, 2000(Forrester et al, , 2005.…”

Predictors of Death and Survival Duration Among a Sample of Persons Living With HIV/AIDS

“…The effect of alcohol use on mortality appears less studied than injection drug use or other drug use. Recent studies suggest there may be complex relationships between alcohol use, emotional status, medication adherence, homelessness, or possibly direct detrimental physiological effects on the body (Molina, Lang, McNurlan, Bagby, & Nelson, 2008;Quatch et al, 2008;Walley et al, 2008). The current study adds to the literature indicating that assessment of alcohol use and interventions for heavy use may increase survival in the era of HAART.…”