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Kline MDA, Daniels C, Xu X, Sunil T, Ganesan A, Agan BK, Colombo RE, Kronmann KC, Blaylock JM, Okulicz JF, Markelz AE. Antiretroviral Therapy Anchor-based Trends in Body Mass Index Following Treatment Initiation Among Military Personnel with HIV. Mil Med 2021; 186:279-285. [PMID: 33128552 DOI: 10.1093/milmed/usaa416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/30/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the U.S. Military HIV Natural History Study (NHS). MATERIALS AND METHODS NHS participants with available baseline weight and height data initiating ART from 2006 to 2017 were considered for analysis. Antiretroviral therapy was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI (<25 vs ≥25 kg/m2) at ART start and anchor drug class. These models were adjusted for demographic- and HIV-related characteristics. RESULTS Of 961 NHS participants started on initial ART between 2006 and 2017, 491 men who had available baseline BMI data and were virally suppressed (<200 c/mL) at 1 and 2 years of follow-up were included. Overall, the predicted BMI increased at each time point over 2 years regardless of baseline BMI. There was a trend toward less weight gain for non-INSTI regimens regardless of demographic- or HIV-related factors (-0.65 kg/m2/yr, P = .070). In participants with BMI <25, all regimens were associated with BMI gains except in those with high viral load (≥100,000 copies/mL) started on PI regimens (-1.91 kg/m2/yr, P = .000; n = 13). For those participants with BMI ≥25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54 kg/m2/y, P = .000; PI 0.39 kg/m2/yr, P = .006). Non-nucleoside reverse transcriptase inhibitors were not associated with weight gain regardless of race- or HIV-related characteristics. African Americans with BMI ≥25 were more likely to gain weight as compared to Whites (0.99 kg/m2/yr, P = .016). Specific anchor drug-based predictions revealed that only INSTI use among African Americans was significantly associated with BMI gains (1.85 kg/m2/yr, P = .007); NNRTI- and PI-related weight change was not significant as compared to Whites. CONCLUSIONS In our cohort of young military members with HIV infection, those with BMI <25 experienced BMI gains across all ART classes. Among those with BMI ≥25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.
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Affiliation(s)
| | - Colton Daniels
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Xiaohe Xu
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Thankam Sunil
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.,Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.,Madigan Army Medical Center, Tacoma, WA 98431, USA
| | | | - Jason M Blaylock
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jason F Okulicz
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA
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Millett GA, Honermann B, Jones A, Lankiewicz E, Sherwood J, Blumenthal S, Sayas A. White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses. AIDS Patient Care STDS 2020; 34:417-424. [PMID: 32833494 PMCID: PMC7585613 DOI: 10.1089/apc.2020.0155] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emerging epidemiological data suggest that white Americans have a lower risk of acquiring COVID-19. Although many studies have pointed to the role of systemic racism in COVID-19 racial/ethnic disparities, few studies have examined the contribution of racial segregation. Residential segregation is associated with differing health outcomes by race/ethnicity for various diseases, including HIV. This commentary documents differing HIV and COVID-19 outcomes and service delivery by race/ethnicity and the crucial role of racial segregation. Using publicly available Census data, we divide US counties into quintiles by percentage of non-Hispanic white residents and examine HIV diagnoses and COVID-19 per 100,000 population. HIV diagnoses decrease as the proportion of white residents increase across US counties. COVID-19 diagnoses follow a similar pattern: Counties with the highest proportion of white residents have the fewest cases of COVID-19 irrespective of geographic region or state political party inclination (i.e., red or blue states). Moreover, comparatively fewer COVID-19 diagnoses have occurred in primarily white counties throughout the duration of the US COVID-19 pandemic. Systemic drivers place racial minorities at greater risk for COVID-19 and HIV. Individual-level characteristics (e.g., underlying health conditions for COVID-19 or risk behavior for HIV) do not fully explain excess disease burden in racial minority communities. Corresponding interventions must use structural- and policy-level solutions to address racial and ethnic health disparities.
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Affiliation(s)
| | - Brian Honermann
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Austin Jones
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Elise Lankiewicz
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Jennifer Sherwood
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Susan Blumenthal
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Asal Sayas
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
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