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Madlala HP, Myer L, Geffen H, Rusch J, Shey MS, Meyer D, Goedecke JH, Malaba TR, Gray CM, Newell ML, Jao J. Inflammatory markers in pregnancy are associated with postpartum weight in South African women living with HIV on antiretroviral therapy. J Acquir Immune Defic Syndr 2024:00126334-990000000-00387. [PMID: 38465914 PMCID: PMC11371938 DOI: 10.1097/qai.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Postpartum weight (PPW) contributes to long-term obesity, a growing concern in persons with HIV (PWH). We investigated whether inflammatory markers in pregnancy may be involved in postpartum (PP) obesity in PWH. SETTING A total of 57 pregnant PWH enrolled at ≤14 weeks gestation (T1) in Gugulethu antenatal care clinic in Cape Town and followed through 48 weeks PP were included. METHODS Plasma soluble (s) CD14, sCD163, leptin, tumour necrosis factor receptor 1 (TNFR-1), resistin, adiponectin, and interleukin-6 (IL-6) were assayed in duplicate using the Luminex platform. We considered each inflammatory marker at T1 (n=57) and T3 (29-36 weeks gestation, n=31) as a separate exposure of interest. Linear mixed effects models were fit to examine whether each exposure was associated with average PPW and PPW trajectories; linear regression was used for associations with PPW change between T1 and 48 weeks. RESULTS Median age was 32 years (IQR, 29-35), 98% were multigravida, and 49% had a BMI≥30 kg/m2. Higher T1 sCD14 levels were associated with higher average weight through 48 weeks PP (ß = 0.002, p=0.04), and T3 sCD14 with higher PPW gain (ß = 0.007, p=0.04). Leptin (ß = 0.414, p<0.01), TNFR-1 (ß = 11.048, p<0.01) and resistin (ß = 0.714, p=0.01) at T3 were associated with higher average PPW, and IL-6 (ß = 2.266, p=0.02) with PPW gain. CONCLUSION These findings suggest that low-grade inflammation in pregnancy may play a role in postpartum obesity, pointing to potential mechanisms with implications for long-term cardiometabolic health in PWH.
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Affiliation(s)
- Hlengiwe P Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Hayli Geffen
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Jody Rusch
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Muki S Shey
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Demi Meyer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Julia H Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Clive M Gray
- Division of Molecular Biology and Human Genetics, University of Stellenbosch, Cape Town, South Africa
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Marie-Louise Newell
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jennifer Jao
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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2
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Patel YS, Doshi AD, Levesque AE, Lindor S, Moranville RD, Okere SC, Robinson DB, Taylor L, Lustberg ME, Malvestutto CD. Weight Gain in People with HIV: The Role of Demographics, Antiretroviral Therapy, and Lifestyle Factors on Weight. AIDS Res Hum Retroviruses 2023; 39:652-661. [PMID: 37276145 DOI: 10.1089/aid.2023.0008] [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] [Indexed: 06/07/2023] Open
Abstract
We explored factors associated with weight gain among people with HIV (PWH) on antiretroviral therapy (ART) at The Ohio State University Wexner Medical Center (OSUWMC). This was a retrospective cohort study of adult PWH on ART for ≥3 months. Patients with CD4+ T cell count <200 cells/mm3, viral load >200 copies/mL, history of malignancy, or pregnancy were excluded. Eight hundred seventy patients met criteria. The primary outcome was percent weight change over the follow-up period (Δ = relative effects). The secondary outcome was the odds of ≥5 kg weight gain over the study period. The effects of concurrent medications, medical comorbidities, ART combinations, and lifestyle behaviors on these outcomes were modeled using mixed effects regression analyses. Over a mean follow-up of 1.86 years, the study population gained a mean percent weight of 2.12% ± 0.21% (p < .001) with the odds of ≥5 kg weight gain of 0.293 (p < .001). Males gained an average of 1.88% ± 0.22% over follow up, while females gained an average of 3.37% ± 0.51% over follow up (p = .008 for the difference). In regression models, combination therapy with tenofovir alafenamide (TAF) and integrase strand transfer inhibitor (INSTI) containing regimens was associated with an increase in weight over the study period (Δ = 2.14% ± 0.45%, p < .001 and Δ = 1.09% ± 0.39%, p = .005, respectively). Increasing age was significantly associated with a decrease in percent weight change over the study period (Δ = -0.68% ± 0.18% per year, p < .001). Self-reported improvement in diet was associated with a decrease in weight change (Δ = -1.99% ± 0.47%, p ≤ .001) and reduced odds of ≥5 kg weight gain (odds ratio = 0.70, 95% confidence interval = 0.50-0.97, p = .03). Factors associated with weight gain include therapy with TAF and INSTI. Diet may play an influential role in attenuating weight gain in PWH.
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Affiliation(s)
- Yesha S Patel
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anjali D Doshi
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anna E Levesque
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Shelsie Lindor
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Sheila C Okere
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Lauren Taylor
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark E Lustberg
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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3
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Hachey D, van Woerden I, Shiluama R, Singu BS. Weight gain in Namibians with HIV switching from efavirenz to dolutegravir. Int J STD AIDS 2023; 34:854-859. [PMID: 37309139 DOI: 10.1177/09564624231179767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research suggests that integrase strand transferase inhibitor use can lead to weight gain, and data from sub-Saharan countries are limited. This study investigated changes in weight in Namibians switched from tenofovir DF/emtricitabine/efavirenz (TEE) to tenofovir DF/lamivudine/dolutegravir (TLD). METHODS Longitudinal, retrospective, and quantitative study from outpatient records of Namibians living with HIV/AIDS switched from efavirenz-to dolutegravir-based regimen at four clinics. A linear mixed effects model predicting weight 6 months prior to the switch, time of the switch, and at 6, 12-, and 18-months post-switch was run. A second analysis comparing change in weights between males and females was also run. RESULTS 242 patients switched from TEE to TLD. Compared to patient weight at the time of the switch, weights were significantly higher at 6 (+0.9 kg, p = 0.004), 12 (+1.7 kg, p < 0.001), and 18 months (+1.4 kg, p < 0.001) post-switch. There was no significant weight change for males, but females had a significant weight gain at 12 (+1.58 kg, p = 0.012) and 18 months (+1.49 kg, p = 0.024) post switch. CONCLUSIONS Females living with HIV in Namibia gain weight when switched from TEE to TLD. Clinical implications on the development of cardiometabolic complications is unclear and mechanisms by which the weight gain occurs are unknown.
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Affiliation(s)
- David Hachey
- Department of Family Medicine, Idaho State University, Pocatello, ID, United States
- Department of Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
| | - Irene van Woerden
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
| | - Roselli Shiluama
- Department of Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
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4
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Cechin L, Norcross C, Oliveira A, Hopkins D, McGowan B, Post FA. Obesity and diabetes in people of African ancestry with HIV. HIV Med 2022; 24:380-388. [PMID: 36196017 DOI: 10.1111/hiv.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
Obesity is a chronic disease with multiple adverse effects on health. The prevalence of obesity is increasing worldwide, and people of African ancestry are disproportionally affected. Several widely used antiretrovirals have been associated with weight gain and contribute to the rising burden of obesity in people with HIV. Obesity and weight gain on antiretroviral therapy are risk factors for the development of type 2 diabetes mellitus, a condition which also disproportionally affects black populations. In this review, we discuss recent data on weight gain in relation to initiating or switching antiretroviral therapy and advances in the management of obesity. Availability of highly effective treatments for obesity have the potential to address, and potentially reverse, the epidemics of obesity and diabetes mellitus in people with HIV.
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Affiliation(s)
- Laura Cechin
- King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Norcross
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - David Hopkins
- King's College Hospital NHS Foundation Trust, London, UK.,Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.,Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
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5
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Sapuła M, Suchacz M, Załęski A, Wiercińska-Drapało A. Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review. Viruses 2022; 14:122. [PMID: 35062326 PMCID: PMC8780416 DOI: 10.3390/v14010122] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 12/13/2022] Open
Abstract
The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980's. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.
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Affiliation(s)
- Mariusz Sapuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, 01-201 Warsaw, Poland; (M.S.); (A.Z.); (A.W.-D.)
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6
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Goupil de Bouillé J, Vigouroux C, Plessis L, Ghislain M, Teglas JP, Boufassa F, Goujard C, Vignes D, Bouchaud O, Salmon D, Meyer L, Abgrall S. Factors Associated With Being Overweight and Obesity in People Living With Human Immunodeficiency Virus on Antiretroviral Therapy: Socioclinical, Inflammation, and Metabolic Markers. J Infect Dis 2021; 224:1570-1580. [PMID: 33740044 DOI: 10.1093/infdis/jiab151] [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] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We investigated the association between socioclinical, inflammatory, and metabolic markers and weight gain in people with human immunodeficiency virus (HIV) on combination antiretroviral therapy (cART). METHODS Individuals from the COPANA cohort of normal weight (body mass index [BMI], 18.5-24.9 [ calculated as weight in kilograms divided by height in meters squared) at cART initiation who achieved virological suppression (viral load, <50 copies/mL) and maintained it through 36 months of treatment were selected. Clinical, immunovirological, and socioeconomic data and inflammation (high-sensitivity C-reactive protein, CXCL10, CXCL8, interleukin 6, soluble tumor necrosis factor receptors 1 and 2, soluble CD14, and soluble CD16) and serum metabolic (glucose, insulin, lipid profile, adiponectin, and leptin) markers were assessed. Factors associated with becoming overweight (BMI, 25-29.9) or obese (BMI, ≥30) at 36 months were assessed using multivariate logistic regression models. RESULTS After 36 months of cART, 32 of 158 people with HIV (20%) became overweight or obese (21% female; 65% born in France and 23% born in sub-Saharan Africa; median BMI at cART initiation, 22 [interquartile range, 21-23]). After adjustment, higher BMI, originating from sub-Saharan Africa, living in a couple, and higher soluble tumor necrosis factor receptor 2 and lower adiponectin concentrations at cART initiation were associated with becoming overweight or obese. CONCLUSION Weight gain on cART is multifactorial. Special attention should be given to migrants from sub-Saharan Africa. Monocyte activation and adipocyte dysfunction at cART initiation affect weight regulation.
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Affiliation(s)
- Jeanne Goupil de Bouillé
- APHP, Hôpital Avicenne, Service de Maladies Infectieuses et Tropicales, Bobigny, France.,Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France
| | - Corinne Vigouroux
- AP-HP, Hôpital Saint-Antoine, Centre de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité, Service d'Endocrinologie et Laboratoire Commun de Biologie et Génétique Moléculaires, Paris, France.,Sorbonne Université, Inserm U938, Centre de Recherche Saint-Antoine, Paris, France
| | - Lorraine Plessis
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France
| | - Mathilde Ghislain
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France
| | - Jean-Paul Teglas
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France
| | - Faroudy Boufassa
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France.,AP-HP, Hôpital Bicêtre, Service de Médecine Interne, Le Kremlin-Bicêtre, France
| | - Dorothée Vignes
- AP-HP, Hôpital Béclère, Service de Médecine Interne, Clamart, France
| | - Olivier Bouchaud
- APHP, Hôpital Avicenne, Service de Maladies Infectieuses et Tropicales, Bobigny, France.,Laboratoire Educations et Pratiques de Santé EA 3412, Université Paris 13, Bobigny, France
| | - Dominique Salmon
- AP-HP, Hôpital Hôtel Dieu, Centre de Diagnostic et de Thérapeutique, Paris, France
| | - Laurence Meyer
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France.,AP-HP, Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France
| | - Sophie Abgrall
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Le Kremlin-Bicêtre, France.,AP-HP, Hôpital Béclère, Service de Médecine Interne, Clamart, France
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7
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Surial B, Mugglin C, Calmy A, Cavassini M, Günthard HF, Stöckle M, Bernasconi E, Schmid P, Tarr PE, Furrer H, Ledergerber B, Wandeler G, Rauch A. Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV : A Cohort Study. Ann Intern Med 2021; 174:758-767. [PMID: 33721521 DOI: 10.7326/m20-4853] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain. OBJECTIVE To assess weight changes, the development of overweight/obesity, and changes in lipid levels 18 months after replacing TDF with TAF. DESIGN Cohort study. SETTING 5 university hospitals, affiliated hospitals, and private physicians in Switzerland. PARTICIPANTS 4375 adults living with HIV who received TDF-containing ART for 6 months or longer. MEASUREMENTS Changes in weight and lipid levels were assessed using mixed-effect models. Differences in proportions of newly overweight/obese participants were calculated using 2-proportions Z tests. RESULTS 4375 individuals were included, with follow-up between 1 January 2016 and 31 July 2019. Median age was 50 years (interquartile range, 43 to 56 years), 25.9% were female, and 51.7% had a normal body mass index (BMI); 3484 (79.6%) switched to TAF and 891 (20.4%) continued TDF. After 18 months, switching to TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5 to 2.0 kg), compared with 0.7 kg (CI, 0.4 to 1.0 kg) with the continued use of TDF (between-group difference, 1.1 kg [CI, 0.7 to 1.4 kg]). Among individuals with a normal BMI, 13.8% who switched to TAF became overweight/obese, compared with 8.4% of those continuing TDF (difference, 5.4 percentage points [CI, 2.1 to 8.8 percentage points]). Switching to TAF led to increases in adjusted mean total cholesterol (0.25 mmol/L [9.5 mg/dL]), high-density lipoprotein cholesterol (0.05 mmol/L [1.9 mg/dL]), low-density lipoprotein cholesterol (0.12 mmol/L [4.7 mg/dL]), and triglyceride (0.18 mmol/L [16.1 mg/dL]) levels after 18 months. LIMITATION Short follow-up, small subgroup analyses, and potential residual confounding. CONCLUSION Replacing TDF with TAF is associated with adverse metabolic changes, including weight increase, development of obesity, and worsening serum lipid levels. PRIMARY FUNDING SOURCE Swiss National Science Foundation.
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Affiliation(s)
- Bernard Surial
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Catrina Mugglin
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Alexandra Calmy
- Geneva University Hospital, University of Geneva, Geneva, Switzerland (A.C.)
| | - Matthias Cavassini
- University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland (M.C.)
| | - Huldrych F Günthard
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Marcel Stöckle
- University Hospital Basel, University of Basel, Basel, Switzerland (M.S.)
| | - Enos Bernasconi
- Regional Hospital of Lugano, University of Geneva, and University of Southern Switzerland, Lugano, Switzerland (E.B.)
| | - Patrick Schmid
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland (P.S.)
| | - Philip E Tarr
- and Kantonsspital Baselland, University of Basel, Basel, Switzerland (P.E.T.)
| | - Hansjakob Furrer
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Bruno Ledergerber
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Gilles Wandeler
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Andri Rauch
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
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8
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Sax PE, Erlandson KM, Lake JE, Mccomsey GA, Orkin C, Esser S, Brown TT, Rockstroh JK, Wei X, Carter CC, Zhong L, Brainard DM, Melbourne K, Das M, Stellbrink HJ, Post FA, Waters L, Koethe JR. Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials. Clin Infect Dis 2021; 71:1379-1389. [PMID: 31606734 PMCID: PMC7486849 DOI: 10.1093/cid/ciz999] [Citation(s) in RCA: 427] [Impact Index Per Article: 142.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022] Open
Abstract
Background Initiation of antiretroviral therapy (ART) often leads to weight gain. While some of this weight gain may be an appropriate return-to-health effect, excessive increases in weight may lead to obesity. We sought to explore factors associated with weight gain in several randomized comparative clinical trials of ART initiation. Methods We performed a pooled analysis of weight gain in 8 randomized controlled clinical trials of treatment-naive people living with human immunodeficiency virus (HIV) initiating ART between 2003 and 2015, comprising >5000 participants and 10 000 person-years of follow-up. We used multivariate modeling to explore relationships between demographic factors, HIV disease characteristics, and ART components and weight change following ART initiation. Results Weight gain was greater in more recent trials and with the use of newer ART regimens. Pooled analysis revealed baseline demographic factors associated with weight gain including lower CD4 cell count, higher HIV type 1 RNA, no injection drug use, female sex, and black race. Integrase strand transfer inhibitor use was associated with more weight gain than were protease inhibitors or nonnucleoside reverse transcriptase inhibitors (NNRTIs), with dolutegravir and bictegravir associated with more weight gain than elvitegravir/cobicistat. Among the NNRTIs, rilpivirine was associated with more weight gain than efavirenz. Among nucleoside/nucleotide reverse transcriptase inhibitors, tenofovir alafenamide was associated with more weight gain than tenofovir disoproxil fumarate, abacavir, or zidovudine. Conclusions Weight gain is ubiquitous in clinical trials of ART initiation and is multifactorial in nature, with demographic factors, HIV-related factors, and the composition of ART regimens as contributors. The mechanisms by which certain ART agents differentially contribute to weight gain are unknown.
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Affiliation(s)
- Paul E Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jordan E Lake
- University of Texas Health Science Center, Houston, Texas, USA
| | - Grace A Mccomsey
- University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Chloe Orkin
- Barts Health National Health Service Trust, London, United Kingdom
| | | | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Xuelian Wei
- Gilead Sciences, Inc, Foster City, California, USA
| | | | - Lijie Zhong
- Gilead Sciences, Inc, Foster City, California, USA
| | | | | | - Moupali Das
- Gilead Sciences, Inc, Foster City, California, USA
| | | | - Frank A Post
- King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | | | - John R Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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9
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Obesity Affects the Association of Bioelectrical Impedance Phase Angle With Mortality in People Living With HIV. J Assoc Nurses AIDS Care 2020; 31:51-59. [PMID: 31869313 DOI: 10.1097/jnc.0000000000000077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Bioelectrical impedance analysis phase angle (BIA-PA) is a valid indicator of mortality risk in people living with HIV; however, it is not known whether BIA-PA is valid for people living with HIV who are overweight or obese. We assessed whether BIA-PA differentially predicted mortality by body mass index category in participants receiving clinical care at a single site between 2000 and 2012. Change in BIA-PA from the highest versus last available phase angle was assessed using multivariate logistic regression models. Eight hundred ninety participants were included in the final analyses, with 102 deaths recorded during the study period. Decline in BIA-PA was associated with mortality in underweight and normal weight participants but not in overweight or obese participants. Additional investigation is warranted to determine the appropriate clinical BIA-PA equations and parameters to identify overweight and obese patients with increased mortality risk.
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10
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McMahon C, Trevaskis JL, Carter C, Holsapple K, White K, Das M, Collins S, Martin H, Burns-Naas LA. Lack of an association between clinical INSTI-related body weight gain and direct interference with MC4 receptor (MC4R), a key central regulator of body weight. PLoS One 2020; 15:e0229617. [PMID: 32109250 PMCID: PMC7048285 DOI: 10.1371/journal.pone.0229617] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/10/2020] [Indexed: 02/02/2023] Open
Abstract
An increasing prevalence of overweight and obesity in people living with HIV has been associated with initiation of antiretroviral therapy with integrase strand transfer inhibitors (INSTIs). An off-target inhibition of the endogenous ligand binding to the human melanocortin 4 receptor (MC4R) has been suggested as a potential mechanism for clinical body weight gain following initiation of dolutegravir, an INSTI. In this study, we interrogated several INSTIs for their capacity for antagonism or agonism of MC4R in an in vitro cell-based assays including at concentrations far exceeding plasma concentrations reached at the recommended dosages. Our results indicate that while INSTIs do exhibit the capacity to antagonize MC4R, this occurs at concentrations well above predicted clinical exposure and is thus an implausible explanation for INSTI-associated weight gain.
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Affiliation(s)
- Carrie McMahon
- Gilead Sciences Inc., Foster City, CA, United States of America
- * E-mail:
| | | | | | - Kevin Holsapple
- Gilead Sciences Inc., Foster City, CA, United States of America
| | - Kirsten White
- Gilead Sciences Inc., Foster City, CA, United States of America
| | - Moupali Das
- Gilead Sciences Inc., Foster City, CA, United States of America
| | - Sean Collins
- Gilead Sciences Inc., Foster City, CA, United States of America
| | - Hal Martin
- Gilead Sciences Inc., Foster City, CA, United States of America
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Naidoo P, Naidoo RN, Ramkaran P, Chuturgoon AA. Effect of maternal HIV infection, BMI and NOx air pollution exposure on birth outcomes in South African pregnant women genotyped for the p53 Pro72Arg (rs1042522). Int J Immunogenet 2020; 47:414-429. [PMID: 32080966 DOI: 10.1111/iji.12481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
Tumour suppressor protein, p53, plays a role in modulating innate immune responses, DNA repair, cell cycle arrest, senescence and apoptosis. Maternal nitrogen oxide (NOx) air pollution exposure, body mass index (BMI), human immunodeficiency virus (HIV) infection and p53 Pro72Arg (rs1042522) affect foetal growth. We investigated whether the aforementioned factors influence birth outcomes in a South African population. Pregnant women (n = 300; HIV -ve = 194 and HIV +ve = 106) were genotyped for the p53 rs1042522 using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and further stratified based on HIV status, infants' birthweight (BW; NBW: normal BW [>2,500 g] and LBW: low BW [<2,500 g]) and gestational age (GA; NGA: normal GA [>37 weeks] and PTB: preterm birth [≤37 weeks]). A land use regression model was developed to characterize maternal NOx exposure. Pearson's correlation and multivariate regression analysis statistical tests were used to determine the effect of rs1042522 genotyped pregnant women's BMI and NOx exposure on maternal blood pressure and haemoglobin and iron levels, and infants' anthropometric measurements and Appearance Pulse Grimace Activity and Respiration (APGAR) scores. The prevalence of LBW and PTB was 14.7% and 18.7%, respectively. The LBW group had a higher frequency of the variant Arg-allele versus NBW group (47.7% vs. 31.4%, p = .0046, OR = 2.0, 95% CI = 1.26-3.17). No association was observed between NGA and PTB groups. A significant association between BMI and systolic blood pressure (r = .50, p = .00; B = 0.76, p = .002) and birth length (r = -.28, p = .01; B = -0.107, p = .011), and NOx and birth length (r = -.26, p = .08; B = -0.191, p = .046) and birthweight (B = -8.87, p = .048) was observed in HIV-infected mothers with the variant Pro/Arg + Arg/Arg genotypes. Mothers from the LBW group with the variant genotypes displayed an association between NOx and diastolic blood pressure (r = .58, p = .04), blood iron levels (r = -.60, p = .04; B = -0.204, p = .004), APGAR scores at 1 min (r = -.86, p = .00; B = -0.101, p = .003) and 5 min (r = -.75, p = .01) and birth length (r = -.61, p = .04), and BMI and diastolic blood pressure (r = .72, p = .01). In the PTB group, maternal variant genotypes and NOx were associated with blood haemoglobin levels (B = -0.132, p = .045) and APGAR scores at 1 min (B = -0.161, p = .045) and 5 min (B = -0.147, p = .043). Maternal rs1042522 Arg-allele, HIV infection, BMI and NOx exposure collectively play a role in lowering blood iron levels, gestational hypertension and LBW outcomes.
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Affiliation(s)
- Pragalathan Naidoo
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Prithiksha Ramkaran
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Anil A Chuturgoon
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
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Huis In 't Veld D, Pengpid S, Colebunders R, Peltzer K. Body Mass Index and Waist Circumference in Patients with HIV in South Africa and Associated Socio-demographic, Health Related and Psychosocial Factors. AIDS Behav 2018; 22:1972-1986. [PMID: 28243935 DOI: 10.1007/s10461-017-1737-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A high body mass index (BMI) and high waist circumference are important health risk factors predisposing for cardiovascular and metabolic diseases and certain cancers. Historically, underweight was a diagnostic criterion of HIV-infection. In a cross-sectional study the prevalence of BMI-categories and high waist circumference and its associated factors in patients visiting three outpatient HIV clinics in South Africa were measured with anthropometric measurements and structured questionnaires regarding socio-demographic information, quality of life (QoL), AIDS-related stigma, symptoms of depression, alcohol use, HIV related information and level of adherence to ART. The median age of the 2230 included patients was 37 years, 66.5% were women and 88.6% received antiretroviral therapy. The prevalences of overweight, obesity and high waist circumference were 29.2, 21.9 and 44.6% respectively in women and 12.4, 4.0 and 3.9% respectively in men. Underweight was found in 18.2% of men and 6.3% of women. In multinomial regression analysis compared to a normal BMI, both overweight and obesity were associated with female gender, with being married or cohabiting and with a higher QoL score. Underweight was associated with male gender and tobacco use and negatively associated with being married or cohabiting and the physical domain of the QoL measure. A high waist circumference in men was associated with higher age and negatively associated with tobacco use and stigma score. In women it was negatively associated with never being married. A high prevalence of overweight and obesity was observed in HIV-clinics in South Africa, mainly in women. Since overweight and obesity are important health risk factors, effective weight reduction interventions are desirable.
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Affiliation(s)
- Diana Huis In 't Veld
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
- FWO Research Foundation Flanders, Brussels, Belgium.
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
- Algemeen inwendige geneeskunde, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand
- Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Robert Colebunders
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand
- HIV/AIDS, STIs & TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Limpopo, Sovenga, South Africa
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13
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Schiever JF, Visser J, van der Merwe M, Nel DG. Evaluation of nutrition care to adult patients on HAART attending primary healthcare facilities in Mpumalanga. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2018. [DOI: 10.1080/16070658.2017.1412183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- JF Schiever
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - J Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - M van der Merwe
- Nutrition Sub-Directorate, Department of Health, Mpumalanga Provincial Government , Nelspruit, South Africa
| | - DG Nel
- Centre for Statistical Consultation, University of Stellenbosch , Cape Town, South Africa
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Mathabire Rücker SC, Tayea A, Bitilinyu-Bangoh J, Bermúdez-Aza EH, Salumu L, Quiles IA, Szumilin E, Chirwa Z, Rick F, Maman D. High rates of hypertension, diabetes, elevated low-density lipoprotein cholesterol, and cardiovascular disease risk factors in HIV-infected patients in Malawi. AIDS 2018; 32:253-260. [PMID: 29135581 PMCID: PMC5757671 DOI: 10.1097/qad.0000000000001700] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/12/2017] [Accepted: 10/25/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Data on cardiovascular disease risks among HIV-infected patients taking antiretroviral therapy (ART) over long periods of time are lacking in Sub-Saharan Africa. METHODS A cross-sectional study was conducted in Chiradzulu, Malawi from December 2015 to June 2016. HIV-infected persons on ART for more than 10 years (patients) and HIV-negative individuals (controls) from selected clinics participated. Following informed consent, a standardized questionnaire, clinical and laboratory examinations were performed. The prevalence of cardiovascular disease risk factors was calculated and stratified by age group. RESULTS Overall, 379 HIV-infected patients and 356 controls participated. Median time on ART among patients was 11.6 years (interquartile range 10.6-12.4).Within the 30-44, 45-59, and at least 60-year age groups, respectively, the prevalence of hypertension was 10.8, 20.4, and 44.7% among patients and 6.1, 25.8, and 42.9% among controls. Hypertension was previously undiagnosed in 60.3% patients and 37.0% controls with elevated blood pressure. The prevalence of diabetes within the respective age groups was 5.0, 6.4, and 13.2% among patients, and 3.4, 4.2, and 1.7% among controls. HIV-infected patients were more likely to have an glycated hemoglobin at least 6.0% (adjusted odds ratio 1.9; 95% confidence interval 1.1-3.2, P = 0.02). Prevalence of low-density lipoprotein cholesterol more than 130 mg/dl within the respective age groups was 8.0, 15.4, and 23.7% among patients and 1.8, 12.5, and 11.8% among controls. CONCLUSION Noncommunicable diseases were a significant burden in Malawi, with high prevalence of hypercholesterolemia in all survey participants and an especially acute diabetes burden among older HIV infected. Hypertension screening and treatment services are needed among identified high-risk groups to cover unmet needs.
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Affiliation(s)
| | | | | | | | | | | | | | - Zengani Chirwa
- HIV and AIDS Department, Ministry of Health Malawi, Lilongwe, Malawi
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15
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Kazooba P, Kasamba I, Mayanja BN, Lutaakome J, Namakoola I, Salome T, Kaleebu P, Munderi P. Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy. Pan Afr Med J 2017; 27:40. [PMID: 28761616 PMCID: PMC5516660 DOI: 10.11604/pamj.2017.27.40.9840] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION We investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART). METHODS We collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption). RESULTS We enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI≥25 kg/m2 -26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P<0.001) and hyperglycemia (p<0.005). In multivariate logistic regression analyses, Protease Inhibitor (PI) containing regimens were significantly associated with higher risks of abnormal: Tc, LDL, TG, AIP, abdominal obesity, hypertension, low HDL and lower risk of a FHS >10% compared to the non PI regimen. CONCLUSION ART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended.
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Affiliation(s)
- Patrick Kazooba
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Ivan Kasamba
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Joseph Lutaakome
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Ivan Namakoola
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Tino Salome
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Pontiano Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Paula Munderi
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
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Croffut SE, Hamela G, Mofolo I, Maman S, Hosseinipour MC, Hoffman IF, Bentley ME, Flax VL. HIV-positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28296240 DOI: 10.1111/mcn.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/15/2017] [Accepted: 02/08/2017] [Indexed: 11/29/2022]
Abstract
Before the prevention of mother-to-child transmission (PMTCT) program was widely implemented in Malawi, HIV-positive women associated exclusive breastfeeding with accelerated disease progression and felt that an HIV-positive woman could more successfully breastfeed if she had a larger body size. The relationship between breastfeeding practices and body image perceptions has not been explored in the context of the Option B+ PMTCT program, which offers lifelong antiretroviral therapy. We conducted in-depth interviews with 64 HIV-positive women in Lilongwe District, Malawi to investigate body size perceptions, how perceptions of HIV and body size influence infant feeding practices, and differences in perceptions among women in PMTCT and those lost to follow-up. Women were asked about current, preferred, and healthy body size perceptions using nine body image silhouettes of varying sizes, and vignettes about underweight and overweight HIV-positive characters were used to elicit discussion of breastfeeding practices. More than 80% of women preferred an overweight, obese, or morbidly obese silhouette, and most women (83%) believed that an obese or morbidly obese silhouette was healthy. Although nearly all women believed that an HIV-positive overweight woman could exclusively breastfeed, only about half of women thought that an HIV-positive underweight woman could exclusively breastfeed. These results suggest that perceptions of body size may influence beliefs about a woman's ability to breastfeed. Given the preference for large body sizes and the association between obesity and risk of noncommunicable diseases, we recommend that counseling and health education for HIV-positive Malawian women focus on culturally sensitive healthy weight messaging and its relationship with breastfeeding practices.
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Affiliation(s)
- Samantha E Croffut
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mina C Hosseinipour
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Irving F Hoffman
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Valerie L Flax
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
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17
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Mashinya F, Alberts M, Colebunders R, Van Geertruyden JP. Weight status and associated factors among HIV infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa. Afr J Prim Health Care Fam Med 2016; 8:e1-e8. [PMID: 28155318 PMCID: PMC5153409 DOI: 10.4102/phcfm.v8i1.1230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/12/2016] [Accepted: 09/08/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Underweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD). AIM The study determined weight status and associated factors in people with HIV infection receiving ART. SETTING Rural primary health care clinics in Dikgale, Limpopo province, South Africa. METHODS A cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m2). Data on ART duration were extracted from patients' files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques. RESULTS Of the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, p = 0.001) and male gender (OR: 0.29, p = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, p = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis. CONCLUSION A high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.
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Affiliation(s)
- Felistas Mashinya
- Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo.
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18
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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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19
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Ilozue C, Howe B, Shaw S, Haigh K, Hussey J, Price DA, Chadwick DR. Obesity in the HIV-infected population in Northeast England: a particular issue in Black-African women. Int J STD AIDS 2016; 28:284-289. [PMID: 27147266 DOI: 10.1177/0956462416649131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People living with HIV are surviving longer on successful antiretroviral therapy and obesity rates are increasing. We sought to determine the prevalence of being overweight or obese in a regional population of people living with HIV and to explore the demographic and clinical characteristics associated with obesity or being overweight. Data on patients attending three Northeast England clinics were collected including body mass index and demographics. The prevalence of being overweight (body mass index ≥ 25 kg/m2) or obese (body mass index ≥ 30 kg/m2) was determined and compared with regional population data. Associations between being overweight or obese and demographic and other data were further explored using logistic regression models. In 560 patients studied (median age 45 years, 26% Black-African and 69% male), 65% were overweight/obese and 26% obese, which is similar to the local population. However, 83% and 48% of Black-African women were overweight/obese or obese, respectively, with 11% being morbidly obese (body mass index > 40 kg/m2). In the multivariate analyses, the only factors significantly associated with obesity were Black-African race (adjusted odds ratio 2.78, 95% confidence interval 1.60-4.85) and type 2 diabetes (adjusted odds ratio 4.23, 95% confidence interval 1.81-9.91). Levels of obesity and overweight in people living with HIV are now comparable to the levels in the local population of Northeast England; however, the prevalence is significantly higher in Black-African women. Given the additional risk factors for cardiovascular disease inherent in people living with HIV, better strategies to prevent, identify and manage obesity in this population are needed.
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Affiliation(s)
- C Ilozue
- 1 Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK.,2 Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - B Howe
- 3 Department of Genitourinary Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - S Shaw
- 2 Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - K Haigh
- 1 Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK
| | - J Hussey
- 3 Department of Genitourinary Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - D A Price
- 2 Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - D R Chadwick
- 1 Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK
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20
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Muyanja D, Muzoora C, Muyingo A, Muyindike W, Siedner MJ. High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda. AIDS Patient Care STDS 2016; 30:4-10. [PMID: 26683587 DOI: 10.1089/apc.2015.0213] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objectives of this study were to determine the epidemiology and correlates of cardiovascular disease (CVD) risk among Ugandans on first-line antiretroviral therapy (ART). We conducted a cross-sectional study at an HIV clinic in southwestern Uganda. We enrolled adult patients on non-nucleoside-based ART regimens for a minimum of 2 years. We collected anthropometric and clinical measurements, smoking history, and blood for fasting lipid profile and blood sugar (FBS). Outcomes of interest were (1) presence of metabolic syndrome (at least two of the following: FBS >100 mg/dL, blood pressure of ≥130/85 mmHg, triglycerides ≥150 mg/dL, HDL <40 mg/DL, or waist circumference ≥94 cm in males or ≥80 cm in females); and (2) a Framingham score correlating to >5% 10-year CVD risk. Of the 250 participants enrolled, metabolic syndrome was detected in 145/250 (58%) of participants (62% in females and 50% in males). Forty-three participants (17%) had a Framingham risk correlating to a 5% or greater risk for CVD within 10 years (26% in males and 13% in females). In multivariate analyses, being female (AOR 3.13; 95% CI: 1.0-9.70; p = 0.04) and over 40 years of age (AOR 1.78; 95% CI: 1.00-3.17; p = 0.05) was independently associated with having metabolic syndrome. We found no independent risk factors for a Framingham risk score 10-year risk exceeding 5%, or associations between ART regimen and CVD risk profiles. We conclude that metabolic abnormalities are common among patients on first-line ART in rural Uganda, and appear to be more common in women than men.
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Affiliation(s)
- Daniel Muyanja
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anthony Muyingo
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mark J. Siedner
- Department of Infectious Disease and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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21
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Koethe JR, Jenkins CA, Lau B, Shepherd BE, Justice AC, Tate JP, Buchacz K, Napravnik S, Mayor AM, Horberg MA, Blashill AJ, Willig A, Wester CW, Silverberg MJ, Gill J, Thorne JE, Klein M, Eron JJ, Kitahata MM, Sterling TR, Moore RD. Rising Obesity Prevalence and Weight Gain Among Adults Starting Antiretroviral Therapy in the United States and Canada. AIDS Res Hum Retroviruses 2016; 32:50-8. [PMID: 26352511 PMCID: PMC4692122 DOI: 10.1089/aid.2015.0147] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The proportion of overweight and obese adults in the United States and Canada has increased over the past decade, but temporal trends in body mass index (BMI) and weight gain on antiretroviral therapy (ART) among HIV-infected adults have not been well characterized. We conducted a cohort study comparing HIV-infected adults in the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to United States National Health and Nutrition Examination Survey (NHANES) controls matched by sex, race, and age over the period 1998 to 2010. Multivariable linear regression assessed the relationship between BMI and year of ART initiation, adjusting for sex, race, age, and baseline CD4(+) count. Temporal trends in weight on ART were assessed using a generalized least-squares model further adjusted for HIV-1 RNA and first ART regimen class. A total of 14,084 patients from 17 cohorts contributed data; 83% were male, 57% were nonwhite, and the median age was 40 years. Median BMI at ART initiation increased from 23.8 to 24.8 kg/m(2) between 1998 and 2010 in NA-ACCORD, but the percentage of those obese (BMI ≥30 kg/m(2)) at ART initiation increased from 9% to 18%. After 3 years of ART, 22% of individuals with a normal BMI (18.5-24.9 kg/m(2)) at baseline had become overweight (BMI 25.0-29.9 kg/m(2)), and 18% of those overweight at baseline had become obese. HIV-infected white women had a higher BMI after 3 years of ART as compared to age-matched white women in NHANES (p = 0.02), while no difference in BMI after 3 years of ART was observed for HIV-infected men or non-white women compared to controls. The high prevalence of obesity we observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future.
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Affiliation(s)
- John R. Koethe
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Bryan Lau
- Johns Hopkins University, Baltimore, Maryland
| | | | - Amy C. Justice
- Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Janet P. Tate
- Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John Gill
- Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada
| | | | - Marina Klein
- McGill University Health Center, Montreal, Quebec, Canada
| | - Joseph J. Eron
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Johns Hopkins University, Baltimore, Maryland
- Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- University of North Carolina, Chapel Hill, North Carolina
- Universidad Central del Caribe, Bayamon, Puerto Rico
- Mid-Atlantic Permanente Research Institute, Rockville, Maryland
- Harvard Medical School, Boston, Massachusetts
- University of Alabama at Birmingham, Birmingham, Alabama
- Kaiser Permanente Northern California, Oakland, California
- Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada
- McGill University Health Center, Montreal, Quebec, Canada
- University of Washington, Seattle, Washington
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