Trends and risk factors for obesity among HIV positive Nigerians on antiretroviral therapy

Abstract

Introduction The increased access to antiretroviral therapy has changed the once deadly infection to a chronic medical condition, resulting in a dramatic change in causes of morbidity and mortality among HIV infected individuals. Obesity and its cardiovascular sequelae are increasingly reported in the literature. However, data on the burden, trends and risk factors for obesity are sparse in countries worst hit by the epidemic.Objectives To investigate the trend and risk factors for obesity among a cohort of HIV infected adults on antiretroviral therapy. MethodsWe analysed prospectively collected data in an ongoing longitudinal observational study conducted at the HIV treatment centre, Nigerian Institute of Medical Research, Lagos, Nigeria. Patients who started treatment between June 2004 and December 2009, and completed a five year follow up were included in the analysis. Multivariate analysis was used to determine the risk factors for obesity among the cohort.Results A total of 12 585 adults were enrolled in the treatment programme during the study period. Of which, 8819 (70.1%) met the inclusion criteria. At the start of treatment, 27.0% were either overweight (19.6%) or obese (7.4%) compared to 62.2% that were either overweight (35.7%) or obese (26.5%) at the end of 5 years. The observed differences were statistically significant (p<0.01). Female gender (aOR: 2.2; 95% CI: 1.81-2.67), low baseline BMI less than 20 (aOR: 1.9; 95% CI: 1.3-2.2) and baseline CD4 count less than 350/μl (aOR: 2.51; 95% CI: 2.13 -3.09) were associated with the development of obesity at multivariate analysis. Type of antiretroviral drug, age, marital status, viral load and haemoglobin level were not associated with obesity after controlling for confounding variables.Conclusions Obesity is common among HIV infected Nigerians on antiretroviral therapy and is associated with

The Nutritional Status of Adult Antiretroviral Therapy Recipients with a Recent HIV Diagnosis; A Cross-Sectional Study in Primary Health Facilities in Gauteng, South Africa

“…Those who had been on ART for a longer duration were three times more likely to have developed obesity than those who had been on ART for a short duration. The increase observed in the current study in the prevalence of obesity after the commencement of ART is parallel to the rates reported in Côte d'Ivoire, Tanzania, and Nigeria, where large proportions of HIV-positive individuals were found to have progressed to overweight and obese states after being started on ART [25,41,48]. In cohorts of HIV-infected adults in the U.S., Canada, and Brazil, the prevalence and incidence of obesity after ART initiation continued to increase [49,50].…”

“…This observation is supported by findings from other studies, in which those who had been on ART for a short duration were almost twice as undernourished as those who had been taking the ART for a longer duration [11,44]. The explanation for this observation could be that patients who are undernourished at the time of their enrolment on ART, who might have been suffering from a more advanced stage of the disease, become healthier and gain weight over time, with their recovery from opportunistic infections [41,45]. Research has indicated that patients in an advanced stage of the disease are more likely to be malnourished at the time of enrolment in HIV clinics [37,41].…”

“…The current study found a high (39%) prevalence of overall overweight/obesity, and the prevalence was higher in women than in men. The association observed between gender and overweight/obesity has been previously documented [39][40][41]. The study established that age was also a factor associated with overweight.…”

“…The explanation for this observation could be that patients who are undernourished at the time of their enrolment on ART, who might have been suffering from a more advanced stage of the disease, become healthier and gain weight over time, with their recovery from opportunistic infections [41,45]. Research has indicated that patients in an advanced stage of the disease are more likely to be malnourished at the time of enrolment in HIV clinics [37,41]. However, evidence suggests that weight gain is common among HIV-positive individuals initiating ART [46].…”

HIV Co-Morbidities and Multi-Morbidities

“…It is worth noting that in the Hispanic cohort (above) of HIV patients receiving antiviral therapy the incidence of obesity/overweight was similar to that witnessed in high income countries with the expected accompanying risks [61]. Further, Obesity linked to commonplace among HIV-infected Nigerians maintaining antiretroviral therapy [64].…”