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Bailin SS, Koethe JR, Rebeiro PF. The pathogenesis of obesity in people living with HIV. Curr Opin HIV AIDS 2024; 19:6-13. [PMID: 37934696 PMCID: PMC10842175 DOI: 10.1097/coh.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The public health challenge of overweight and obesity increasingly affects people living with HIV (PWH). These effects have also accelerated as the prevalence of antiretroviral therapy (ART) use has increased among PWH. It is therefore also critical that we examine and understand the pathogenesis of obesity among PWH.This review will aim to summarize relevant and recent literature related to the risks of weight gain and obesity associated with HIV disease progression, cardiometabolic disease, and multimorbidity among PWH. Further, we will discuss adipose tissue changes associated with weight gain and obesity and how these changes relate to metabolic complications. RECENT FINDINGS Several observational and experimental studies in recent years have evaluated the role of contemporary ART regimens, particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF), as contributors to weight gain, obesity, and cardiometabolic disease, though the mechanisms remain unclear. Metabolic dysregulation has also been linked to ectopic fat deposition and alterations in innate and adaptive immune cell populations in adipose tissue that accompany HIV and obesity. These factors continue to contribute to an increasing burden of metabolic diseases in an aging HIV population. SUMMARY Obesity accompanies an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
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Affiliation(s)
| | - John R Koethe
- Department of Medicine, Division of Infectious Diseases
| | - Peter F Rebeiro
- Department of Medicine, Division of Infectious Diseases
- Department of Medicine, Division of Epidemiology
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Ditzenberger GL, Oliveira VHF, Jankowski CM, Erlandson KM. The use of non-invasive imaging modalities for the assessment of skeletal muscle quantity and quality in people with HIV: A narrative review. HIV Med 2023; 24:1176-1189. [PMID: 37651982 DOI: 10.1111/hiv.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND People with HIV (PWH) are prone to mobility impairments and physical dysfunction, with the loss of skeletal muscle quantity and quality being a major contributor to the dysfunction. Assessment of skeletal muscle is an important component of care for this patient population for early intervention and treatment. The use of non-invasive imaging techniques to evaluate skeletal muscle, such as dual X-ray absorptiometry, computer tomography and magnetic resonance imaging, has increased in popularity in recent years. PURPOSE This narrative review synthesizes the use of these techniques and summarizes the associations between outcomes from these imaging modalities and physical function in PWH.
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Solanke T, Kamau F, Esterhuizen T, Maartens G, Khoo S, Joska JA, Kellermann T, Strijdom H, Decloedt EH. Concentrations of Efavirenz, Tenofovir, and Emtricitabine in Obesity: A Cross-Sectional Study. J Acquir Immune Defic Syndr 2022; 91:101-108. [PMID: 35972856 DOI: 10.1097/qai.0000000000003025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity is increasing worldwide including in people living with HIV (PLWH). Antiretroviral pharmacokinetic data in obesity are limited. OBJECTIVES To measure antiretroviral drug concentrations in obese and nonobese PLWH treated with the fixed-dose combination of efavirenz-tenofovir-emtricitabine. To determine pharmacokinetic differences across indicators of obesity and their associated immunovirological outcomes. METHODS We conducted a cross-sectional sample analysis of 2 cohort studies. We measured mid-dose efavirenz, 8-hydroxy-efavirenz, tenofovir, and emtricitabine concentrations. Antiretroviral drug concentrations were analyzed by body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). RESULTS We performed a study of 213 participants: General obesity was detected in 20.4% using BMI and abdominal obesity in 53.6% using WC and 62.4% using WHR, respectively. The median concentrations of all antiretroviral drugs were lower among obese participants determined by BMI and WC, with efavirenz showing greater differences than tenofovir or emtricitabine. For BMI, results were most striking for efavirenz (1752.3 vs 2342.9 ng/mL, P = 0.002) with lower concentrations in obese participants. Using WC, efavirenz (1845.8 vs 2571.2 ng/mL, P < 0.001), tenofovir (65.8 vs 73.2 ng/mL, P = 0.036), and emtricitabine (159.5 vs 221.0 ng/mL, P = 0.005) concentrations were lower in obese participants. Eight-hydroxyefavirenz concentrations were similar in nonobese and obese participants for WC. Using WHR, the concentrations of all antiretroviral drugs were lower in the obese population, most strikingly for emtricitabine (173.5 vs 229.0 ng/mL, P = 0.015). There were no immunovirological associations. CONCLUSION We found lower antiretroviral concentrations in all obese groups, most strikingly in participants with abdominal obesity determined by WC. Lower drug concentrations had no immunovirological associations.
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Affiliation(s)
- Toyosi Solanke
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Festus Kamau
- Division of Medical Physiology, Department of Biomedical Sciences, Centre for Cardio-metabolic Research in Africa (CARMA), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tonya Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Biostatistics Unit, Stellenbosch University, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool; and
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Department of Biomedical Sciences, Centre for Cardio-metabolic Research in Africa (CARMA), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Lake JE, Overton T, Naggie S, Sulkowski M, Loomba R, Kleiner DE, Price JC, Chew KW, Chung RT, Corey KE. Expert Panel Review on Nonalcoholic Fatty Liver Disease in Persons With Human Immunodeficiency Virus. Clin Gastroenterol Hepatol 2022; 20:256-268. [PMID: 33069882 PMCID: PMC9069630 DOI: 10.1016/j.cgh.2020.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) affects 25% of adults in the general population and is a disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) to end-stage liver disease. NAFLD is an independent risk factor for cardiovascular disease, diabetes mellitus, and all-cause mortality, and NASH cirrhosis is a frequent indication for liver transplantation. In persons with human immunodeficiency virus (PWH), chronic liver disease is the second leading cause of non-human immunodeficiency virus-related mortality. Between 20% and 63% of PWH have NASH, and 14% to 63% have NASH with fibrosis. However, little is known about the optimal diagnostic strategies, risk factors for, and treatment of NAFLD in PWH. Here, we review current data on and identify knowledge gaps in the epidemiology, pathophysiology, diagnosis, and management of NAFLD in PWH and highlight priorities for research.
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Affiliation(s)
- Jordan E Lake
- Division of Infectious Disease, University of Texas Health Sciences Center at Houston, Houston, Texas.
| | - Turner Overton
- Division of Infectious Disease, University of Alabama School of Medicine, Birmingham, Alabama
| | - Susanna Naggie
- Division of Infections Disease, Duke University School of Medicine, Durham, North Carolina
| | - Mark Sulkowski
- Division of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rohit Loomba
- Division of Gastroenterology, University of California San Diego School of Medicine, San Diego, California
| | - David E Kleiner
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Jennifer C Price
- Division of Gastroenterology, University of California San Francisco School of Medicine, San Francisco, California
| | - Kara W Chew
- Division of Infectious Diseases, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Raymond T Chung
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kathleen E Corey
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Dirajlal-Fargo S, Jacobson DL, Yu W, Mirza A, Geffner ME, Jao J, McComsey GA. Gut Dysfunction Markers Are Associated With Body Composition in Youth Living With Perinatally Acquired Human Immunodeficiency Virus. Clin Infect Dis 2022; 75:945-952. [PMID: 35090002 PMCID: PMC9522403 DOI: 10.1093/cid/ciac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The association between gut dysfunction and body fat composition in youth living with perinatal human immunodeficiency virus infection (YPHIV) has not been investigated. METHODS We included YPHIV aged 7-19 years from the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol with plasma available within 6 months of baseline whole-body dual energy x-ray absorptiometry (DXA) and HIV RNA ≤1000 copies/mL within 3 months of baseline DXA and a second DXA 2 years later. Plasma markers of bacterial translocation and gut barrier dysfunction (lipopolysaccharide binding protein [LBP], zonulin, and intestinal fatty acid binding protein [I-FABP]) were measured at baseline by enzyme-linked immunosorbent assay and log10 transformed. Adiposity outcomes included percentage total body, truncal, and extremity fat in kilograms from DXA. Linear regression models were fit using generalized estimating equations to assess associations of baseline gut markers (log10) on adiposity outcomes at baseline and 2 years, adjusted for demographic variables, current antiretroviral therapy exposure, and physical activity. RESULTS Two hundred sixty-one youth were included; 128 had a second DXA. Median age at first DXA was 12 years (interquartile range, 10-14 years), 49% were female, and 69% were Black. After adjustment for potential confounders, log10 LBP was positively associated with percentage total body fat at baseline (β = 4.08, P < .01) and zonulin with adiposity measures at both time points (β = .94 to 6.50, P ≤ .01). I-FABP was inversely associated with percentage total body fat at baseline and year 2 (β = -2.36 and -3.01, respectively, P ≤ .02). CONCLUSIONS Despite viral suppression, gut damage and the resultant bacterial translocation are associated with body composition measures in YPHIV.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- Correspondence: S. Dirajlal-Fargo, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH 44106 ()
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wendy Yu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ayesha Mirza
- University of Florida Health, Jacksonville, Florida, USA
| | - Mitchell E Geffner
- Saban Research Institute of Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Jennifer Jao
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Grace A McComsey
- Rainbow Babies and Children’s Hospital and Case Western Reserve University, Cleveland, Ohio, USA
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Chang HH. Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients. Infect Chemother 2022; 54:220-235. [PMID: 35706080 PMCID: PMC9259920 DOI: 10.3947/ic.2022.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
While human immunodeficiency virus (HIV)-associated wasting has declined with significant advances in antiretroviral therapy (ART), weight gain and metabolic syndrome (MetS) are now becoming a problem for people living with HIV (PLWH) worldwide. The development of a new and more effective ART regimen has increased viral suppression and improved immunologic function recovery, leading to the extension of the lifespan of PLWH. It has recently been reported as one of the significant factors associated with weight gain, obesity, and long-term metabolic consequences in PLWH. This article reviewed the epidemiology of overweight and MetS among PLWH and the known risk factors for weight gain and its major comorbidities, such as dyslipidemia, diabetes mellitus, cardiovascular diseases, neurocognitive disorders, and liver diseases, in PLWH. In addition, reports on the pharmacological and surgical management of overweight and obesity in PLWH has been briefly summarized.
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Affiliation(s)
- Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Lopez-Alvarenga JC, Martinez DA, Diaz-Badillo A, Morales LD, Arya R, Jenkinson CP, Curran JE, Lehman DM, Blangero J, Duggirala R, Mummidi S, Martinez RD. Association of HIV-1 Infection and Antiretroviral Therapy With Type 2 Diabetes in the Hispanic Population of the Rio Grande Valley, Texas, USA. Front Med (Lausanne) 2021; 8:676979. [PMID: 34291061 PMCID: PMC8287129 DOI: 10.3389/fmed.2021.676979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022] Open
Abstract
The Rio Grande Valley (RGV) in South Texas has one of the highest prevalence of obesity and type 2 diabetes (T2D) in the United States (US). We report for the first time the T2D prevalence in persons with HIV (PWH) in the RGV and the interrelationship between T2D, cardiometabolic risk factors, HIV-related indices, and antiretroviral therapies (ART). The PWH in this study received medical care at Valley AIDS Council (VAC) clinic sites located in Harlingen and McAllen, Texas. Henceforth, this cohort will be referred to as Valley AIDS Council Cohort (VACC). Cross-sectional analyses were conducted using retrospective data obtained from 1,827 registries. It included demographic and anthropometric variables, cardiometabolic traits, and HIV-related virological and immunological indices. For descriptive statistics, we used mean values of the quantitative variables from unbalanced visits across 20 months. Robust regression methods were used to determine the associations. For comparisons, we used cardiometabolic trait data obtained from HIV-uninfected San Antonio Mexican American Family Studies (SAMAFS; N = 2,498), and the Mexican American population in the National Health and Nutrition Examination Survey (HHANES; N = 5,989). The prevalence of T2D in VACC was 51% compared to 27% in SAMAFS and 19% in HHANES, respectively. The PWH with T2D in VACC were younger (4.7 years) and had lower BMI (BMI 2.43 units less) when compared to SAMAFS individuals. In contrast, VACC individuals had increased blood pressure and dyslipidemia. The increased T2D prevalence in VACC was independent of BMI. Within the VACC, ART was associated with viral load and CD4+ T cell counts but not with metabolic dysfunction. Notably, we found that individuals with any INSTI combination had higher T2D risk: OR 2.08 (95%CI 1.67, 2.6; p < 0.001). In summary, our results suggest that VACC individuals may develop T2D at younger ages independent of obesity. The high burden of T2D in these individuals necessitates rigorously designed longitudinal studies to draw potential causal inferences and develop better treatment regimens.
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Affiliation(s)
- Juan Carlos Lopez-Alvarenga
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | | | - Alvaro Diaz-Badillo
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Liza D. Morales
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Rector Arya
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Christopher P. Jenkinson
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Joanne E. Curran
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Donna M. Lehman
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - John Blangero
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Ravindranath Duggirala
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Srinivas Mummidi
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
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Dolutegravir is not associated with weight gain in antiretroviral therapy experienced geriatric patients living with HIV. AIDS 2021; 35:939-945. [PMID: 33635844 PMCID: PMC9904432 DOI: 10.1097/qad.0000000000002853] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to explore weight gain in people with HIV (PWH) at least 65 years of age who switch to a DTG based regimen (DTG-s) vs. remaining INSTI-naive (INSTI-n) on stable ART. METHODS This was a longitudinal prospective study of PWH from the GEPPO cohort. At the beginning of the observational period, participants were INSTI-naives (INSTI-n). During follow-up, they were divided in two groups: INSTI-n vs. dolutegravir-switchers (DTG-s) with no further change in ART. Body weight was assessed at baseline and at last follow-up visit. Significant weight gain was defined as an increase at least 5% of baseline weight from the first to the last visit. ART regimens were collected at each patients' visit. Kaplan--Meier curves were drawn to assess time to reach a weight gain more than 5%. RESULTS Out of 568 PWH (83.1% men, median age 69.5 years), 427 (75%) were INSTI-n and 141 (25%) DTG-s. After an average follow-up of 2.6 (±0.8) years, no significant change in body weight was observed both among INSTI-n [delta weight = 0.02 (±7.5), P = 0.633] and DTG-s [delta weight = -0.04 (±5.2), P = 0.755]. Weight gain was also not significantly different between study groups (9.3% in INSTI-n and 15.1% in DTG-S: P = 0.175). No significant differences in time to achieve a weight gain greater or equal than 5% of baseline weight emerged in INSTI-n vs. DTG-s (P = 0.93), two-drug regimens (2DR) vs. three-drug regimens (3DR) (P = 0.56) or TAF vs. TDF (P = 0.56). CONCLUSION Results from a large Italian cohort did not show a significant weight gain associated with switch to DTG in PWH 65 years of age or older. This finding emerged also when comparing 3DR vs. 2DR and TAF exposed and unexposed geriatric PWH.
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Affiliation(s)
- Lucia Taramasso
- Infectious Disease Unit, Department of Internal Medicine, IRCCS Policlinic San Martino Hospital, Genoa, Italy
| | - Jack T Stapleton
- Departments of Internal Medicine, Microbiology and Immunology, The University of Iowa and Iowa City Veterans Administration Healthcare System, Iowa City, IA
| | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Kabthymer RH, Nega Techane S, Muche T, Ali Ewune H, Mekonnen Abate S, Feyisso Shaka M. Overweight and Obesity Among Adult HIV Infected Peoples Receiving ART in Ethiopia: A Systematic Review and Meta-Analysis. J Prim Care Community Health 2021; 12:2150132721993647. [PMID: 33543684 PMCID: PMC7874346 DOI: 10.1177/2150132721993647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Over-nutrition and diet-linked non-communicable morbidities are showing increasing trend overtime. Even if there are different factors that affect the change in BMI other than ART, several authors have reported increases in BMI among PLHIV on treatment that are equal to or surpass the general population. This study is aimed to estimate the prevalence of obesity and overweight among adult HIV infected peoples taking ART in Ethiopia. METHOD PubMed, CINAHL, Web of science, global health and Google scholar electronic databases were used to perform a systematic literature search. Two authors independently extracted all the necessary data using a structured data extraction format. Data analysis was done using STATA Version 14. The heterogeneity of the studies was assessed by using I2 test. A random-effects model was used to estimate the pooled prevalence. Publication bias was checked using Funnel plot and Egger's test. RESULT Two thousand seven hundred and fifty-one studies were reviewed and 13 studies fulfilling the inclusion criteria were included in the meta-analysis. The meta-analysis of 13 studies, comprising 4994 participants resulted in pooled prevalence of overweight to be 17.85% (95% CI: 12.22-23.47). Whereas, the pooled prevalence of overweight was found to be 3.90 (95% CI: 2.31-5.49) but after adjusting for publication bias using trim and fill analysis it has become 3.58 (95% CI: 2.04-5.13). Magnitude of both overweight and obesity was higher in studies conducted in Addis Ababa, studies done after 2016 and studies having sample size of less than 400, in subgroup analysis. CONCLUSION The magnitude of overweight and obesity among HIV infected peoples taking ART in Ethiopia is high. There is a need to have a routine screening to PLWHA on the risk of over-nutrition in order to facilitate early detection.
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Affiliation(s)
| | | | - Temesgen Muche
- College of health sciences and medicine, Dilla University, Dilla, Ethiopia
| | - Helen Ali Ewune
- College of health sciences and medicine, Dilla University, Dilla, Ethiopia
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Olawepo JO, Pharr JR, Cross CL, Kachen A, Olakunde BO, Sy FS. Changes in body mass index among people living with HIV who are new on highly active antiretroviral therapy: a systematic review and meta-analysis. AIDS Care 2020; 33:326-336. [PMID: 32460518 DOI: 10.1080/09540121.2020.1770181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m2; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I 2 = 85%; p < .01). Subgroup analyses showed pooled ES of 1.54 kg/m2 (95% CI: 1.21, 1.87) and 1.63 kg/m2 (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and >1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6-12 months on treatment, with minor gains in the second and subsequent years of treatment.
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Affiliation(s)
- John O Olawepo
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Chad L Cross
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Department of Radiation Oncology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Axenya Kachen
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Francisco S Sy
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
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Abstract
Obesity and chronic disease are growing problems among people living with HIV (PLWH) across the globe. While a variety of treatments have been developed to address cardiovascular and metabolic disease among PLWH, few treatments have focused on helping PLWH and obesity lose weight. In the general population, behavioral weight loss interventions (i.e., diet, physical activity, and behavior therapy) are the first-line treatment for adults for whom weight loss is recommended. However, little research has tested whether the benefits of these programs translate to PLWH. This paper highlights the key components of behavioral weight loss programs, their outcomes in the general population and in the few studies of PLWH, and suggestions for tailoring these programs for PLWH. Behavioral weight loss programs are a strong potential treatment for reducing the burden of obesity among PLWH and merit future research attention.
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Abstract
PURPOSE OF REVIEW The proportion of overweight and obese persons with HIV (PWH) has increased since the introduction of antiretroviral therapy (ART). We aim to summarize recent literature on risks of weight gain, discuss adipose tissue changes in HIV and obesity, and synthesize current understanding of how excess adiposity and HIV contribute to metabolic complications. RECENT FINDINGS Recent studies have implicated contemporary ART regimens, including use of integrase strand transfer inhibitors and tenofovir alafenamide, as a contributor to weight gain, though the mechanisms are unclear. Metabolic dysregulation is linked to ectopic fat and alterations in adipose immune cell populations that accompany HIV and obesity. These factors contribute to an increasing burden of metabolic diseases in the aging HIV population. Obesity compounds an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV- and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
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Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - Curtis L Gabriel
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - John R Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA.
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Potential role of the melanocortin signaling system interference in the excess weight gain associated to some antiretroviral drugs in people living with HIV. Int J Obes (Lond) 2020; 44:1970-1973. [PMID: 32080347 DOI: 10.1038/s41366-020-0551-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
Exposure to some antiretroviral drugs, especially integrase strand transfer inhibitors (INsTI)-based combination antiretroviral therapy (cART) has been associated with weight gain in people living with HIV (PLWH) exceeding what would be a "return to health" phenomenon. Notwithstanding the fact that weight gain and obesity are multifactorial, the common epidemiological link in PLWH is INsTI-based cART. Here, we postulate that interference with the melanocortin system (MCS) functioning by INsTI plays an essential role in excess weight gain and obesity in PLWH, similar to disturbances caused by melanocortin receptor (MCR) mutations in the general population and by antipsychotic therapy in psychiatric patients.
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15
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Barceló C, Guidi M, Thorball CW, Hammer C, Chaouch A, Scherrer AU, Hasse B, Cavassini M, Furrer H, Calmy A, Haubitz S, Bernasconi E, Buclin T, Fellay J, Tarr PE, Csajka C. Impact of Genetic and Nongenetic Factors on Body Mass Index and Waist-Hip Ratio Change in HIV-Infected Individuals Initiating Antiretroviral Therapy. Open Forum Infect Dis 2020; 7:ofz464. [PMID: 31988971 PMCID: PMC6974740 DOI: 10.1093/ofid/ofz464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022] Open
Abstract
Objective There is limited data on abdominal obesity and the influence of genetics on weight change after antiretroviral therapy (ART) initiation. We assessed body mass index (BMI) and waist hip ration (WHR) change over time in the Swiss HIV Cohort study (SHCS). Methods Mixed-effects models characterizing BMI and WHR change over time in 1090 SHCS participants initiating ART between 2005 and 2015 were developed and used to quantify the influence of demographics, clinical factors, and genetic background. Results Individuals with CD4 nadir <100 cells/µL gained 6.4 times more BMI than individuals with ≥200, and 2.8 times more WHR than individuals with ≥100 (P < .001) during the first 1.5 and 2.5 years after ART initiation, respectively. The risk of being overweight or obese after 1.5 years increased with CD4 nadir <100 cells/µL compared to 100–199 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.63–2.74) and ≥200 (OR, 1.69; 95% CI, 1.26–2.32), persisting after 10 years of ART. The risk of abdominal obesity after 2.5 years increased with CD4 nadir <100 compared to ≥100 (OR, 1.35; 95% CI, 1.17–1.54 [in men]; OR, 1.36; 95% CI, 1.18–1.57 [in women]), persisting after 10 years of ART. No significant differences were found across antiretroviral drug classes or genetic scores. Conclusions The risk of general and abdominal obesity increased with CD4 nadir <100 cells/µL. Based on our results, including the genetic background would not improve obesity predictions in HIV-infected individuals.
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Affiliation(s)
- Catalina Barceló
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Lausanne, Switzerland
| | - Monia Guidi
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Lausanne, Switzerland.,Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Christian W Thorball
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Christian Hammer
- Department of Cancer Immunology, Genentech, South San Francisco, CA, USA.,Department of Human Genetics, Genentech, South San Francisco, CA, USA
| | - Aziz Chaouch
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Switzerland
| | | | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sebastian Haubitz
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital, Lugano, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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16
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize knowledge of the prevalence, relevant physiology, and consequences of obesity and visceral adiposity in HIV-infected adults, including highlighting gaps in current knowledge and future research directions. RECENT FINDINGS Similar to the general population, obesity prevalence is increasing among HIV-infected persons, and obesity and visceral adiposity are associated with numerous metabolic and inflammatory sequelae. However, HIV- and antiretroviral therapy (ART)-specific factors may contribute to fat gain and fat quality in treated HIV infection, particularly to the development of visceral adiposity, and sex differences may exist. Obesity and visceral adiposity commonly occur in HIV-infected persons and have significant implications for morbidity and mortality. Future research should aim to better elucidate the HIV- and ART-specific contributors to obesity and visceral adiposity in treated HIV infection, with the goal of developing targeted therapies for the prevention and treatment of obesity and visceral adiposity in the modern ART era.
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Affiliation(s)
- Jordan E Lake
- University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 2.112, Houston, TX, 77030, USA.
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17
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Pedro MN, Rocha GZ, Guadagnini D, Santos A, Magro DO, Assalin HB, Oliveira AG, Pedro RDJ, Saad MJA. Insulin Resistance in HIV-Patients: Causes and Consequences. Front Endocrinol (Lausanne) 2018; 9:514. [PMID: 30233499 PMCID: PMC6133958 DOI: 10.3389/fendo.2018.00514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Here we review how immune activation and insulin resistance contribute to the metabolic alterations observed in HIV-infected patients, and how these alterations increase the risk of developing CVD. The introduction and evolution of antiretroviral drugs over the past 25 years has completely changed the clinical prognosis of HIV-infected patients. The deaths of these individuals are now related to atherosclerotic CVDs, rather than from the viral infection itself. However, HIV infection, cART, and intestinal microbiota are associated with immune activation and insulin resistance, which can lead to the development of a variety of diseases and disorders, especially with regards to CVDs. The increase in LPS and proinflammatory cytokines circulating levels and intracellular mechanisms activate serine kinases, resulting in insulin receptor substrate-1 (IRS-1) serine phosphorylation and consequently a down regulation in insulin signaling. While lifestyle modifications and pharmaceutical interventions can be employed to treat these altered metabolic functions, the mechanisms involved in the development of these chronic complications remain largely unresolved. The elucidation and understanding of these mechanisms will give rise to new classes of drugs that will further improve the quality of life of HIV-infected patients, over the age of 50.
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Affiliation(s)
- Marcelo N. Pedro
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Guilherme Z. Rocha
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Dioze Guadagnini
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Andrey Santos
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Daniela O. Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Heloisa B. Assalin
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Alexandre G. Oliveira
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
- Biosciences Institute, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rogerio de Jesus Pedro
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Mario J. A. Saad
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
- *Correspondence: Mario J. A. Saad
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18
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Erlandson KM, Fiorillo SP, Cardoso SW, Riviere C, Sanchez J, Hakim J, Kumarasamy N, Badal-Faesen S, Lalloo U, Kumwenda J, Campbell TB, Brown TT. Insulin-Like Growth Factor Is Associated with Changes in Body Composition with Antiretroviral Therapy Initiation. AIDS Res Hum Retroviruses 2017; 33:929-934. [PMID: 28403619 DOI: 10.1089/aid.2016.0327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Growth hormone (GH)/insulin-like growth factor (IGF)-1 axis abnormalities have been associated with body composition changes among HIV-infected persons with wasting or lipodystrophy. Little is known of GH/IGF-1 axis alterations with antiretroviral therapy (ART) initiation or differing ART therapies. The AIDS Clinical Trials Group Prospective Evaluation of Antiretrovirals in Resource-Limited Settings (PEARLS) study was a prospective, randomized clinical trial of ART initiation with emtricitabine/tenofovir + efavirenz (FTC/TDF+EFV) versus lamivudine/zidovudine + efavirenz (3TC/ZDV+EFV) in HIV-1-infected individuals from resource-diverse settings. IGF-1 was measured from baseline, week 48, and week 96 stored serum samples. Multivariate models were constructed. 415 participants were included: 170 (41%) were randomized to FTC/TDF+EFV and 245 (59%) to 3TC/ZDV+EFV. The mean age was 35 years, 60% were black, 42% women. The mean IGF-1 level did not change significantly from baseline to week 96 (-0.65 ng/ml; 95% confidence interval (CI) -5.18-3.87), p = .78 and there were no differences by treatment arm at week 96, p = .74. Lower baseline IGF-1 was associated with age, non-white race, greater waist-hip ratio (WHR), low CD4 count, and lower baseline albumin (all p < .01) but not plasma HIV-1 RNA, body mass index, or treatment arm. Greater change in IGF-1 from baseline to 96 weeks was associated with female sex, smaller WHR change, lower baseline albumin, and higher baseline HIV-1 RNA (all p < .01). ART initiation with either ZDV or TDF did not significantly impact overall IGF-1 levels. Baseline and on-treatment changes in IGF-1 with ART initiation may be related to the body composition changes that occur after ART initiation.
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Affiliation(s)
| | | | | | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington
| | - James Hakim
- Department of Medicine, University of Zimbabwe-College of Health Sciences, Harare, Zimbabwe
| | | | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Umesh Lalloo
- Durban International Clinical Research Site, Durban, South Africa
| | | | | | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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19
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Abstract
OBJECTIVE A greater burden of physical function impairment occurs in HIV-infected adults; the impact of antiretroviral therapy (ART) initiation on muscle density (less dense = more fat), a measure of muscle quality, is unknown. DESIGN AIDS Clinical Trials Group Study A5260s, a cardiometabolic substudy of A5257, randomized HIV-infected, ART-naive adults to ritonavir-boosted atazanavir, darunavir, or raltegravir with tenofovir/emtricitabine backbone. Single-slice abdominal computed tomography scans from baseline and week 96 were reanalyzed for total and lean muscle area and density. METHODS Two-sample t-tests described the differences between baseline and week 96 variables. Linear regression analysis was used to explore the role of a priori identified variables and potential confounders. RESULTS Participants (n = 235) were mostly men (90%); 31% were Black non-Hispanic; 21% were Hispanic. Over 96 weeks, small but significant increases were seen in oblique/transverse abdominal, rectus, and psoas muscle total area (range 0.21-0.83 cm; P < 0.05) but not the lean muscle component (all P ≥ 0.33). Significant decreases in overall density, consistent with increases in fat, were seen in all muscle groups (range -0.87 to -2.4 HU; P < 0.01); for the lean muscle component, only decreases in oblique/transverse abdominal and rectus reached statistical significance (P < 0.05). In multivariable analyses, Black race was associated with increased muscle density and female sex with decreased density; treatment arm was not associated with changes in mass or density. CONCLUSION The ART-associated increase in muscle area, regardless of regimen, is likely a reflection of increased fat within the muscle. The consequences of fatty infiltration of muscle on subsequent muscle function require further investigation.
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20
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Erlandson KM, Lake JE. Fat Matters: Understanding the Role of Adipose Tissue in Health in HIV Infection. Curr HIV/AIDS Rep 2016; 13:20-30. [PMID: 26830284 DOI: 10.1007/s11904-016-0298-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than one-third of adults in the USA are obese and obesity-related disease accounts for some of the leading causes of preventable death. Mid-life obesity may be a strong predictor of physical function impairment later in life regardless of body mass index (BMI) in older age, highlighting the benefits of obesity prevention on health throughout the lifespan. Adipose tissue disturbances including lipodystrophy and obesity are prevalent in the setting of treated and untreated HIV infection. This article will review current knowledge on fat disturbances in HIV-infected persons, including therapeutic options and future directions.
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Affiliation(s)
- Kristine M Erlandson
- University of Colorado-Anschutz Medical Center, 12700 E 19th Ave, Mailstop B168, Aurora, CO, USA.
| | - Jordan E Lake
- University of California, Los Angeles, 11075 Santa Monica Blvd., Ste. 100, Los Angeles, CA, USA.
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21
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Papagianni M, Tziomalos K. Obesity in patients with HIV infection: epidemiology, consequences and treatment options. Expert Rev Endocrinol Metab 2016; 11:395-402. [PMID: 30058909 DOI: 10.1080/17446651.2016.1220297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Even though wasting used to characterize patients with HIV infection prior to the antiretroviral therapy (ART) era, obesity is becoming increasingly prevalent in this population. Areas covered: In the present review, we discuss the epidemiology, consequences and treatment options for obesity in patients with HIV infection. Expert commentary: Obesity exerts a multitude of detrimental cardiometabolic effects and appears to contribute to the increasing cardiovascular mortality of this population. However, there are very limited data on the optimal management of obesity in patients with HIV infection. Given the potential for interactions between antiobesity agents and ART that might compromise viral control, lifestyle changes should represent the cornerstone for the prevention and management of obesity in HIV infection.
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Affiliation(s)
- Marianthi Papagianni
- a First Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Konstantinos Tziomalos
- a First Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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22
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Mave V, Erlandson KM, Gupte N, Balagopal A, Asmuth DM, Campbell TB, Smeaton L, Kumarasamy N, Hakim J, Santos B, Riviere C, Hosseinipour MC, Sugandhavesa P, Infante R, Pillay S, Cardoso SW, Tripathy S, Mwelase N, Berendes S, Andrade BB, Thomas DL, Bollinger RC, Gupta A. Inflammation and Change in Body Weight With Antiretroviral Therapy Initiation in a Multinational Cohort of HIV-Infected Adults. J Infect Dis 2016; 214:65-72. [PMID: 26962236 DOI: 10.1093/infdis/jiw096] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/02/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Both wasting and obesity are associated with inflammation, but the extent to which body weight changes influence inflammation during human immunodeficiency virus infection is unknown. METHODS Among a random virologically suppressed participants of the Prospective Evaluation of Antiretrovirals in Resource-Limited Settings trial, inflammatory markers were measured at weeks 0, 24, and 48 after antiretroviral therapy (ART) initiation. Associations between both baseline and change in body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and changes in inflammation markers were assessed using random effects models. RESULTS Of 246 participants, 27% were overweight/obese (BMI, ≥ 25), and 8% were underweight (BMI < 18.5) at baseline. After 48 weeks, 37% were overweight/obese, and 3% were underweight. While level of many inflammatory markers decreased 48 weeks after ART initiation in the overall group, the decrease in C-reactive protein (CRP) level was smaller in overweight/obese participants (P = .01), and the decreases in both CRP (P = .01) and interleukin 18 (P = .02) levels were smaller in underweight participants. Each 1-unit gain in BMI among overweight/obese participants was associated with a 0.02-log10 increase in soluble CD14 level (P = .05), while each 1-unit BMI gain among underweight participants was associated with a 9.32-mg/L decrease in CRP level (P = .001). CONCLUSIONS Being either overweight or underweight at ART initiation was associated with heightened systemic inflammation. While weight gain among overweight/obese persons predicted increased inflammation, weight gain among underweight persons predicted reduced inflammation.
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Affiliation(s)
- Vidya Mave
- Johns Hopkins University-BJ Medical College Clinical Research Site, Pune, India Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | | | - Nikhil Gupte
- Johns Hopkins University-BJ Medical College Clinical Research Site, Pune, India Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Ashwin Balagopal
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - David M Asmuth
- Department of Medicine, University California Davis, Sacramento
| | | | - Laura Smeaton
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Breno Santos
- Hospital Nossa Senhora de Conceição, Porto Alegre, Brazil
| | | | | | | | | | - Sandy Pillay
- Durban International Clinical Research Site, Durban University of Technology, South Africa
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Noluthando Mwelase
- Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Sima Berendes
- Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre Liverpool School of Tropical Medicine, United Kingdom
| | - Bruno B Andrade
- Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, and Instituto Brasileiro para a Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Robert C Bollinger
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Amita Gupta
- Johns Hopkins University-BJ Medical College Clinical Research Site, Pune, India Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
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