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 diseases rates have increased in HIV+ 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-naïve patients initiating therapy at the University of Alabama - Birmingham 1917 HIV/AIDS Clinic from 2000– 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 overweight to obese BMI categories. Greater increases in BMI were observed in patients with baseline CD4 count < 50 cells/μl (3.4 ± 4.1, P<0.01) and boosted protease inhibitor use (2.5±4.1 P=0.01), but did not account for all of the variation observed in weight change. Conclusions The findings that almost half of patients were overweight or obese at ART initiation, and 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.

Nutritional Status and CD4 Cell Counts in HIV/AIDS Patients under Highly Active Antiretroviral Therapy in Addis Ababa, Ethiopia

“…The prevalence of excess weight (overweight or obesity) was higher than the prevalence of malnutrition. This finding was in agreement with Tyler Tate et al report [11].…”

Effects of nutritional education and lifestyle modification on the nutritional status of HIV positive patients: results of a cluster randomized intervention over a period of six months

“…Besides the long known wasting syndrom observed in HIV patients recent studies indicate changes in the nutritional profile of HIV infected patients [10,11,23,24]. In this study, authors observed that more than 50% of the study participants in both the intervention and control group were overweight/ obese at baseline ( Table 2).…”

“…Previously overweight/obesity in HIV/AIDS was associated with HAARTS intake [8,26]. Recent evidence exists that HAARTS represents just a modest contribution to weight gain in HIV patients and that many HIV patients are already overweight/ obese before HAARTS initiation [11]. A possible reason for this tendency could be lack of knowledge on adequate nutrition [10].…”

“…Studies have shown that the current physical activity guideline for adults of 25-30 minutes of moderate intensity physical activity daily would limit health risks for chronic diseases but would likely be insufficient for preventing weight gain [21,22]. Moreover, even if evidence exist that mild-to-moderate obesity is associated with reduced rates of mortality in HIV patients [29,30], its later consequences on health are far more severe than advantages [8,11,24].…”

“…Recently, studies report increasing prevalence of overweight and obesity in HIV patients prior to the initiation of antiretroviral therapy [9][10][11]. This is an indication that HAARTS is not the single contributing factor to overweight/obesity observed in HIV/AIDS patients, but also inadequate dietary habits and lifestyle [11].…”