Obesity Among HIV-Infected Adults Receiving Medical Care in the United States

Thompson‐Paul, Angela M.; Wei, Stanley C.; Mattson, Christine L.; Robertson, McKaylee; Hernández-Romieu, Alfonso C; Bell, Tanvir K.; Skarbinski, Jacek

doi:10.1097/md.0000000000001081

Cited by 48 publications

(18 citation statements)

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“…The overweight and obesity rates in the SANHANES-1 were 20.1% (95% CI: 13.7–26.4) and 11.6% (95% CI: 7.5–15.7) in men and 26.4% (95% CI: 21.7–31.0) and 44.8% (95% CI: 38.8–50.8) in women, respectively. Similar findings have been reported in the United States where obesity levels in HIV-infected men (19%) and women (42%) were comparable to the general population (men: 24.7%, women: 37%) [ 17 ]. It is thus important to assess adiposity in HIV-infected individuals and to implement appropriate management strategies for weight reduction, similar to general populations.…”

Section: Discussionsupporting

confidence: 87%

“…While obesity and HIV infection have been extensively researched separately, there is a dearth of data on the distribution of obesity phenotypes in HIV-infected people [ 17 ]. Therefore, in the current study, we assessed the distribution of obesity phenotypes, and the effects if any, of ART and other major distinctive characteristics of HIV infection, in a representative sample of people with HIV recruited across primary healthcare facilities in the Western Cape Province, South Africa.…”

Section: Introductionmentioning

confidence: 99%

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The Distribution of Obesity Phenotypes in HIV-Infected African Population

et al. 2016

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The distribution of body size phenotypes in people with human immunodeficiency virus (HIV) infection has yet to be characterized. We assessed the distribution of body size phenotypes overall, and according to antiretroviral therapy (ART), diagnosed duration of the infection and CD4 count in a sample of HIV infected people recruited across primary care facilities in the Western Cape Province, South Africa. Adults aged ≥ 18 years were consecutively recruited using random sampling procedures, and their cardio-metabolic profile were assessed during March 2014 and February 2015. They were classified across body mass index (BMI) categories as normal-weight (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2), and further classified according to their metabolic status as “metabolically healthy” vs. “metabolically abnormal” if they had less than two vs. two or more of the following abnormalities: high blood glucose, raised blood pressure, raised triglycerides, and low HDL-cholesterol. Their cross-classification gave the following six phenotypes: normal-weight metabolically healthy (NWMH), normal-weight metabolically abnormal (NWMA), overweight metabolically healthy (OvMH), overweight metabolically abnormal (OvMA), obese metabolically healthy (OMH), and obese metabolically abnormal (OMA). Among the 748 participants included (median age 38 years (25th–75th percentiles: 32–44)), 79% were women. The median diagnosed duration of HIV was five years; the median CD4 count was 392 cells/mm3 and most participants were on ART. The overall distribution of body size phenotypes was the following: 31.7% (NWMH), 11.7% (NWMA), 13.4% (OvMH), 9.5% (OvMA), 18.6% (OMH), and 15.1% (OMA). The distribution of metabolic phenotypes across BMI levels did not differ significantly in men vs. women (p = 0.062), in participants below vs. those at or above median diagnosed duration of HIV infection (p = 0.897), in participants below vs. those at or above median CD4 count (p = 0.447), and by ART regimens (p = 0.205). In this relatively young sample of HIV-infected individuals, metabolically abnormal phenotypes are frequent across BMI categories. This highlights the importance of general measures targeting an overall improvement in cardiometabolic risk profile across the spectrum of BMI distribution in all adults with HIV.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

The Distribution of Obesity Phenotypes in HIV-Infected African Population

et al. 2016

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“…If height was missing (n=1534 (17.7%) in MMP), BMI category was inferred from recorded weight using previously published methods. 16 In NHANES, BMI was measured using standardized techniques and equipment. BMI ≥30 kg/m 2 was considered indicative of obesity.…”

Section: Methodsmentioning

confidence: 99%

Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009–2010

Hernández-Romieu

Garg

Rosenberg

et al. 2017

BMJ Open Diab Res Care

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175

121

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BackgroundNationally representative estimates of diabetes mellitus (DM) prevalence among HIV-infected adults in the USA are lacking, and whether HIV-infected adults are at increased risk of DM compared with the general adult population remains controversial.MethodsWe used nationally representative survey (2009–2010) data from the Medical Monitoring Project (n=8610 HIV-infected adults) and the National Health and Nutrition Examination Survey (n=5604 general population adults) and fit logistic regression models to determine and compare weighted prevalences of DM between the two populations, and examine factors associated with DM among HIV-infected adults.ResultsDM prevalence among HIV-infected adults was 10.3% (95% CI 9.2% to 11.5%). DM prevalence was 3.8% (CI 1.8% to 5.8%) higher in HIV-infected adults compared with general population adults. HIV-infected subgroups, including women (prevalence difference 5.0%, CI 2.3% to 7.7%), individuals aged 20–44 (4.1%, CI 2.7% to 5.5%), and non-obese individuals (3.5%, CI 1.4% to 5.6%), had increased DM prevalence compared with general population adults. Factors associated with DM among HIV-infected adults included age, duration of HIV infection, geometric mean CD4 cell count, and obesity.Conclusions1 in 10 HIV-infected adults receiving medical care had DM. Although obesity contributes to DM risk among HIV-infected adults, comparisons to the general adult population suggest that DM among HIV-infected persons may develop at earlier ages and in the absence of obesity.

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“…Being overweight and obese is highly prevalent among PWH worldwide and varies by sex [10, 11] and geographic region [12]. Obesity is characterized by excessive ectopic fat deposition, which is related to cardiovascular disease [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in the Association of Fat and Inflammation Among People with Treated HIV Infection

Chen

Hung

Yun

et al. 2019

PAI

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Introduction: Ectopic fat deposition may contribute to chronic inflammation in people with HIV (PWH). To inform future mechanistic studies of metabolic risk in this population, we sought to determine which fat measures relate more strongly to inflammation and whether the fat-inflammation relationship is modified by sex or HIV status.Methods: We conducted a cross-sectional study of 105 PWH and 20 age- and sex-matched HIV-negative controls. Interleukin-6 (IL-6) and high-sensitivity C reactive protein (hs-CRP) levels were measured from plasma. Pericardial fat (PCF) and thoracic periaortic adipose tissue (TAT) volumes and peri-right coronary artery (RCA), left atrium (LA) roof and liver densities were measured from cardiac CT scans. Unadjusted and multivariate adjusted linear regression models were used to determine the relationship between ectopic fat measures and inflammation biomarkers.Results: Forty subjects had BMI <25, 33 had BMI 25-30, and 52 had BMI >30. Systolic blood pressure and insulin resistance increased with BMI. Subjects with higher BMI had higher CD4+ count. In models adjusted for demographics, HIV status and metabolic risk factors, BMI was positively associated with IL-6 and hs-CRP. Ectopic PCF and TAT volumes were positively associated with IL-6 and hs-CRP; however, these relationships were somewhat attenuated in adjusted models. LA roof (but not peri-RCA) fat radiodensity was inversely associated with hs-CRP in fully adjusted models and the association with IL-6 was borderline statistically significant. IL-6 was more strongly associated with BMI and LA roof density in women than in men (p for interaction=0.05).Conclusions: Among PWH on antiretroviral therapy, higher BMI and excessive visceral fat burden were associated with circulating markers of systemic inflammation, and this relationship appears to be stronger in women compared to men.

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Obesity Among HIV-Infected Adults Receiving Medical Care in the United States

Abstract: Supplemental digital content is available in the text

Cited by 48 publications

References 48 publications

The Distribution of Obesity Phenotypes in HIV-Infected African Population

The Distribution of Obesity Phenotypes in HIV-Infected African Population

Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009–2010

Sex Differences in the Association of Fat and Inflammation Among People with Treated HIV Infection

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