Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana

Abstract

An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI ≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18.0–24.9 kg/m2 and seventy-eight participants with BMI ≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count <250 cells/μl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0.218; 95% CI 0.068, 0.701; P = 0.011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0.855; 95% CI 0.741, 0.987; P = 0.033) and the combined outcome of having CD4 cell count ≤250/μl and AIDS-defining conditions, whichever occurred earlier (HR 0.918; 95% CI 0.847, 0.994; P= 0.036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.

Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV

“…Adipokines are also associated with upregulation of pro‐inflammatory responses along with the production of other cytokines such as tumour necrosis factor α and interleukin‐6, and this can lead to different cardiometabolic complications [6]. Several studies among PLHIV have also identified a relationship between pre‐treatment BMI and not only HIV disease progression but also other non‐AIDS events, especially CVD [16,32,33]. In this study, PLHIV who were overweight and obese at ART initiation had increased hazards for developing CVD risk factors than those with normal BMI.…”

Predictive effects of body mass index on immune reconstitution among HIV-infected HAART users in China

“…Typically, obesity can increase the risk of numerous deleterious health consequences in general populations, including hypertension, coronary artery disease, myocardial infarction, diabetes and stroke [4, 5]. In the pre-HAART era, obesity has been associated with delayed disease progression among HIV-infected patients [6, 7]. However, the effects of BMI on immune reconstitution after initiating HAART remain inconsistent.…”

Effects of Six-Month Tualang Honey Supplementation on Physiological and Biochemical Profiles in Asymptomatic, Treatment-naïve HIV-infected Patients

“…In contrast, lower BMI (18-20 kg/m 2 ) was linked to significant HIV disease progression. 20 In this study, the BMI values for all groups were within optimal range (20-23 kg/m 2 ). HIV patients have greater risk of mortality due to non-AIDS-related death which include cardiovascular diseases.…”

“…16,17 In this study, no significant differences in the body weight and BMI at baseline, three-months and six-months follow-up were observed between control and honey-supplemented groups, similar to the findings reported by Woods et al (2002) 18 and Alo et al (2014) 19 In addition, a study in Botswana found that the BMI of HIV-infected adults not on ART remained stable throughout the 18 months followup period. 20 Hence, six-month follow-up in this study may not be enough to reflect the disease progression. Another possible reason for the insignificant differences between control and honey-supplemented groups observed may be explained by relatively adequate and well-balanced diet from the prison.…”