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Sampath C, Harris EP, Berthaud V, Tabatabai MA, Wilus DM, Crayton MA, Moss K, Webster-Cyriaque J, Southerland JH, Koethe JR, Gangula PR. Periodontal Treatment Reduces Circulating Pro-Inflammatory Cytokine and Chemokine Levels in African American HIV+ Individuals with Virological Suppression. J Dent Appl 2022; 8:477-487. [PMID: 36274905 PMCID: PMC9583701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Introduction Periodontal Disease (PD), a chronic inflammatory disease, is highly prevalent among Persons Living With HIV (PLWH) and is characterized by microbial symbiosis and oxidative stress. Our hypothesis stipulates that periodontal therapy attenuates systemic inflammatory and bacterial burden while improving periodontal status in PLWH. Methods Sixteen African Americans (AA) with suppressed HIV viremia on long-term Antiretroviral Therapy (ART) were recruited to this study. Participants were placed into two groups, based on their dental care status: group 1 (In-Care, IC) and group 2 (Out of Care, OC). Periodontal health was investigated at baseline, 3 months, 6 months, and 12 months. Cytokine/chemokines, microbial phyla, and Asymmetric Dimethylarginine (ADMA, a marker for endothelial cell dysfunction) levels were assessed in the serum. Statistical comparisons between groups and at different visits were performed using multiple comparison tests. Results Across longitudinal visits, periodontal treatment significantly reduced the levels of several cytokines and chemokines. At baseline, the out of care group had significantly higher blood levels of ADMA and actinobacteria than the IC group. Periodontal treatment significantly altered the abundance of circulating genomic bacterial DNA for various phyla in out of care group. Conclusions Periodontal treatment interventions effectively attenuated circulating pro-inflammatory cytokines and altered microbial translocation, both critical drivers of systemic inflammation in PLWH.
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Affiliation(s)
- C Sampath
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
| | - E P Harris
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
- Meharry Community Wellness Center, USA
| | | | - M A Tabatabai
- Department of Biostatistics, School of Graduate Studies and Research, USA
| | - D M Wilus
- School of Graduate Studies and Research, USA
| | - M A Crayton
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
| | - K Moss
- Division of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, USA
| | | | - J H Southerland
- University of Texas Medical Branch at Galveston, Galveston, USA
| | - J R Koethe
- Vanderbilt University Medical Center, USA
| | - P R Gangula
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
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Magohe A, Kimario J, Lukmanji Z, Hendricks K, Koethe JR, Neke NM, Tvaroha S, Connor R, Mackenzie T, Waddell R, Maro I, Matee M, Pallangyo K, Bakari M, Horsburgh CR, von Reyn CF. Randomized, controlled trial of a protein-calorie supplement for women coinfected with HIV-TB. Int J Tuberc Lung Dis 2022; 26:798-800. [PMID: 35898141 DOI: 10.5588/ijtld.21.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - J Kimario
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Z Lukmanji
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K Hendricks
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - J R Koethe
- Vanderbilt University School of Medicine, Nashville, TN
| | - N M Neke
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S Tvaroha
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - R Connor
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - T Mackenzie
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - R Waddell
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - I Maro
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - M Matee
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K Pallangyo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - M Bakari
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - C R Horsburgh
- Boston University School of Public Health, Boston, MA, USA
| | - C F von Reyn
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
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Musekwa R, Hamooya BM, Koethe JR, Nzala S, Masenga SK. Prevalence and correlates of hypertension in HIV-positive adults from the Livingstone Central Hospital, Zambia. Pan Afr Med J 2021; 39:237. [PMID: 34659610 PMCID: PMC8498662 DOI: 10.11604/pamj.2021.39.237.29718] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction HIV-infection and treatment with antiretroviral therapy (ART) are risk factors for the development of hypertension, which is more prevalent in people living with HIV compared with the general population. Although there is a shift to Integrase Strand Transfer Inhibitor (INSTI)-based ART across the sub-Saharan Africa, there is limited information with regard to INSTIs and hypertension association in this region, making this, a critical question to address. Hence, the study aimed to determine the relationship between hypertension and ART regimen in people living with HIV. Methods this was a cross-sectional study conducted at the Livingstone Central Hospital, southern province of Zambia. This study utilized programmatic data. Demographic and clinical data of 348 persons living with HIV who had been on ART for more than 2 years was abstracted in the adult ART database registry. Descriptive and inferential statistics were used for analyses of data. Results prevalence of hypertension was 18.4% (n=64). Hypertensives were older than normotensives with median (interquartile range) age of 55 (49, 61) and 46 (41, 52), respectively. At multivariate analysis, age (aOR: 1.07, 95% CI 1.04-1.11; p = 0.001) and body mass index (aOR: 1.10, 95% CI 1.04-1.16; p = 0.002) were positively associated with hypertension. Participants on dolutegravir based regimen were 2 times (aOR: 2.44, 95% CI 1.22-4.86; p = 0.01) more likely to be hypertensive compared to those on non-nucleoside reverse transcriptase inhibitors (efavirenz or nevirapine). Conclusion we confirm that increasing age, body mass index (BMI) and use of dolutegravir are risk factors for hypertension. Close monitoring for persons with HIV with these known risk factors is required.
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Affiliation(s)
- Robert Musekwa
- School of Medicine and Health Sciences, Mulungushi University, Hand Research Group, Livingstone, Zambia
| | - Benson Malambo Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Hand Research Group, Livingstone, Zambia
| | - John Robert Koethe
- Vanderbilt University Medical Center, Nashville, Tennesse United States of America
| | | | - Sepiso Kenias Masenga
- School of Medicine and Health Sciences, Mulungushi University, Hand Research Group, Livingstone, Zambia
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Mulenga LB, Musonda P, Chirwa L, Siwingwa M, Mweemba A, Suwilanji S, Fwoloshi S, Phiri H, Phiri D, Mulenga PL, Chisenga T, Nsakanya R, Shibemba A, Todd J, Nzala S, Kaile T, Kankasa C, Hachaambwa L, Claassen C, Sikazwe I, Koethe JR, Sinkala E, Heimburger DC, Wester CW. Insulin Resistance is Associated with Higher Plasma Viral Load Among HIV-Positive Adults Receiving Longer-Term (1 Year) Combination Antiretroviral Therapy (ART). J Infect Dis Ther 2019; 7:406. [PMID: 35538928 PMCID: PMC9082628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND As HIV-positive persons survive longer due to the success of combination antiretroviral therapy (ART) in decreasing mortality, the burden of non-communicable diseases including diabetes mellitus (DM) is anticipated to rise. HIV is characterized by systemic inflammations, markers of which decrease quickly following ART initiation, but typically do not completely normalize. Inflammation may be accompanied by insulin resistance (IR), and both are implicated in the pathogenesis of DM in HIV-positive individuals. Sub-Saharan Africa accounts for almost two-thirds of the global HIV burden but there are few reports of IR, DM and HIV in this region. We assessed the relationship between IR and viral suppression among HIV-positive adults in the Zambian national ART program. METHODS We conducted a cross-sectional survey evaluating HIV-positive adults that had received first line ART (usually TDF/FTC/EFV) for 12 months (± 3 months). Twenty clinics were sampled systematically based on the random starting-point, sampling interval and cumulative population size. Eligible patients had plasma viral load (VL), fasting insulin, and glucose performed. Insulin resistance was determined using Homeostatic model assessment (HOMA). We determined proportions for each outcome using linearized standard error 95% confidence intervals and summary estimates. Viral suppression was defined according to the detection threshold of<20 copies/mL and treatment failure was defined as VL>1,000 copies/mL. RESULTS Of 473 patients enrolled, 46.8% were male and 53.2% were female. 142 (30%) [95% CI: 0.26-0.34] had IR. Among those with IR, 55 (38.7%) were male whereas 87 (61.3%) were female (p value=0.104). 19% of individuals with IR had treatment failure compared to 5.7% without IR (p value<0.0001). 427 (90.3%) participants had treatment success (VL<1,000 copies/mL), and this was associated with a lower likelihood of IR (odds ratio (OR)=0.26 [0.14, 0.48], p value<0.0001). In addition, a significantly lower proportion of patients with IR were virologically suppressed at one-year compared to individuals without IR, 58% [0.54-0.70] versus 70% [0.65-0.75], respectively (p value=0.042). CONCLUSION In Zambian adults on ART for a year, the development of insulin resistance was strongly associated with suboptimal HIV outcomes, specifically non-viral suppression and treatment failure. Further investigations are warranted to determine if this positive association between IR and VL is causally related, and if so in which direction.
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Affiliation(s)
- LB Mulenga
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Ministry of Health, Ndeke House, Lusaka, Zambia
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - P Musonda
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - L Chirwa
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - M Siwingwa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - A Mweemba
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - S Suwilanji
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - S Fwoloshi
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - H Phiri
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - D Phiri
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - PL Mulenga
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - T Chisenga
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - R Nsakanya
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - A Shibemba
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - J Todd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Nzala
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - T Kaile
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - C Kankasa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - L Hachaambwa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- University of Maryland, Baltimore, MD, USA
| | - C Claassen
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- University of Maryland, Baltimore, MD, USA
| | - I Sikazwe
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- Centre for Infectious Diseases Research, Lusaka, Zambia
| | - JR Koethe
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - E Sinkala
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - DC Heimburger
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
| | - CW Wester
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
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Abstract
BACKGROUND Protein-calorie malnutrition (PCM) is a risk factor for tuberculosis (TB) disease and may affect treatment outcomes. There is currently no recommended macronutrient intervention for improving the outcome of anti-tuberculosis treatment. METHODS We reviewed current literature on PCM and low body mass index (BMI) as risk factors for tuberculous infection and TB disease, and their effects on anti-tuberculosis treatment. We summarize clinical trials of macronutrient supplementation in the treatment of TB. RESULTS PCM is a well-established risk factor for TB disease; however, data on malnutrition and the risk of tuberculous infection are limited. Malnutrition is associated with an increased risk of mortality and relapse of active TB. Clinical trials of macronutrient supplementation during treatment confirm a 2-3 kg improvement in weight gain at 2 months, and may result in improvement in physical function, sputum conversion and treatment completion, but they have not been powered to assess effects on mortality or relapse. CONCLUSION Assessment of dietary intake, food security, and baseline BMI should be standard practice in anti-tuberculosis treatment, along with dietary counselling. As macronutrient supplementation may have modest benefits and is not associated with adverse events, patients with BMI values <18.5 kg/m(2) should be provided with balanced macronutrient supplementation whenever possible.
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Affiliation(s)
- J R Koethe
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
| | - C F von Reyn
- Infectious Disease and International Health, Geisel School of Medicine, Hanover, New Hampshire, USA
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Filteau S, PrayGod G, Woodd SL, Friis H, Heimburger DC, Koethe JR, Kelly P, Kasonka L, Rehman AM. Nutritional status is the major factor affecting grip strength of African HIV patients before and during antiretroviral treatment. Trop Med Int Health 2017; 22:1302-1313. [PMID: 28712113 DOI: 10.1111/tmi.12929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Low grip strength is a marker of frailty and a risk factor for mortality among HIV patients and other populations. We investigated factors associated with grip strength in malnourished HIV patients at referral to ART, and at 12 weeks and 2-3 years after starting ART. METHODS The study involved HIV-infected Zambian and Tanzanian participants recruited to the NUSTART trial when malnourished (body mass index <18.5 kg/m2 ) and requiring ART. The relationship of grip strength to nutritional, infectious and demographic factors was assessed by multivariable linear regression at referral for ART (n = 1742) and after 12 weeks (n = 778) and 2-3 years of ART (n = 273). RESULTS In analyses controlled only for sex, age and height, most nutrition and infection-related variables were associated with grip strength. However, in multivariable analyses, consistent associations were seen for fat-free mass index, mid-upper arm circumference, haemoglobin and systolic blood pressure, and a variable association with fat mass index in men. C-reactive protein and CD4 count had limited independent effects on grip strength, while receiving tuberculosis treatment was associated with weaker grip strength. CONCLUSIONS In this population of originally malnourished HIV patients, poor grip strength was more strongly and independently associated with nutritional than with infection and inflammation variables. Programmes to improve health and survival of HIV patients should incorporate nutritional assessment and management and could use grip strength as a functional indicator of improving nutrition.
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Affiliation(s)
- S Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - G PrayGod
- Mwanza Medical Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - S L Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - H Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - D C Heimburger
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J R Koethe
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P Kelly
- Barts & the London School of Medicine, Queen Mary University of London, London, UK.,University of Zambia School of Medicine, Lusaka, Zambia
| | - L Kasonka
- University Teaching Hospital, Lusaka, Zambia
| | - A M Rehman
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Koethe JR, Jenkins CA, Lau B, Shepherd BE, Silverberg MJ, Brown TT, Blashill AJ, Anema A, Willig A, Stinnette S, Napravnik S, Gill J, Crane HM, Sterling TR. Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010. HIV Med 2015; 16:572-7. [PMID: 25960080 DOI: 10.1111/hiv.12259] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Adipose tissue affects several aspects of the cellular immune system, but prior epidemiological studies have differed on whether a higher body mass index (BMI) promotes CD4 T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count. METHODS We used the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data set to analyse the relationship between pre-treatment BMI and 12-month CD4 T-cell recovery among adults who started ART between 1998 and 2010 and maintained HIV-1 RNA levels < 400 copies/mL for at least 6 months. Multivariable regression models were adjusted for age, race, sex, baseline CD4 count and HIV RNA level, year of ART initiation, ART regimen and clinical site. RESULTS A total of 8381 participants from 13 cohorts contributed data; 85% were male, 52% were nonwhite, 32% were overweight (BMI 25-29.9 kg/m(2) ) and 15% were obese (BMI > 30 kg/m(2) ). Pretreatment BMI was associated with 12-month CD4 T-cell change (P < 0.001), but the relationship was nonlinear (P < 0.001). Compared with a reference of 22 kg/m(2) , a BMI of 30 kg/m(2) was associated with a 36 cells/μL [95% confidence interval (CI) 14, 59 cells/μL] greater CD4 T-cell count recovery among women and a 19 cells/μL (95% CI 9, 30 cells/μL) greater recovery among men at 12 months. At a BMI > 30 kg/m(2) , the observed benefit was attenuated among men to a greater degree than among women, although this difference was not statistically significant. CONCLUSIONS A BMI of approximately 30 kg/m(2) at ART initiation was associated with greater CD4 T-cell recovery at 12 months compared with higher or lower BMI values, suggesting that body composition may affect peripheral CD4 T-cell recovery.
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Affiliation(s)
- J R Koethe
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - C A Jenkins
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - B Lau
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - B E Shepherd
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - T T Brown
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - A Anema
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - A Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Stinnette
- University of North Carolina, Chapel Hill, NC, USA
| | - S Napravnik
- University of North Carolina, Chapel Hill, NC, USA
| | - J Gill
- Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, AB, Canada
| | - H M Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - T R Sterling
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Koethe JR, Jenkins CA, Turner M, Bebawy S, Shepherd BE, Wester CW, Sterling TR. Body mass index and the risk of incident noncommunicable diseases after starting antiretroviral therapy. HIV Med 2015; 16:67-72. [PMID: 25230709 PMCID: PMC4268383 DOI: 10.1111/hiv.12178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Obesity and HIV infection are associated with an increased incidence of noninfectious comorbid medical conditions, but the relationship between body mass index (BMI) and the development of noncommunicable diseases (NCDs) among individuals on antiretroviral therapy (ART) has not been well characterized. METHODS A cohort study of adults initiating ART between 1998 and 2010 at an academic centre with systematic laboratory and clinical data collection, including AIDS and NCD diagnoses, was carried out. The relationship between BMI at ART initiation and the risk of incident cardiovascular, hepatic, renal or oncological NCDs was assessed using Cox proportional hazard models. BMI was fitted using restricted cubic splines and models adjusted for age, sex, race, CD4 count, protease inhibitor use, year of initiation, and prior AIDS-defining illness. RESULTS Among 1089 patients in the analysis cohort, 54% had normal BMI, 28% were overweight, and 18% were obese. Baseline BMI was associated with developing an incident NCD (P<0.01), but the relationship was nonlinear. Compared with a BMI of 25 kg/m(2) , a BMI of 30 kg/m(2) conferred a lower risk of an incident NCD diagnosis [adjusted hazard ratio (AHR) 0.59; 95% confidence interval (CI) 0.40, 0.87]. This protective effect was attenuated at a BMI of 35 kg/m(2) (AHR 0.78; 95% CI 0.49, 1.23). Results were similar in sensitivity analyses incorporating tobacco, alcohol and illicit drug use, statin and antihypertensive exposure, and virological suppression. CONCLUSIONS Overweight individuals starting ART have a lower risk of developing NCDs compared with normal BMI individuals, which may reflect a biological effect of adipose tissue or differences in patient or provider behaviours.
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Affiliation(s)
- J R Koethe
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA
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