An optimal BMI range associated with a lower risk of mortality among HIV-infected adults initiating antiretroviral therapy in Guangxi, China

Abstract

Previous studies investigating HIV-infected patients suggested a direct link between underweight and the mortality rate of AIDS. However, there was a lack of evidence showing the optimal range of initial body mass index (BMI) patients maintain during antiretroviral therapy (ART). We aimed to evaluate associations of the BMI values pre-ART and during the entire ART duration with mortality among HIV-positive individuals. In total, 5101 HIV/AIDS patients, including 1439 (28.2%) underweight, 3047 (59.7%) normal-weight, 548 (10.7%) overweight and 67 (1.3%) obese patients, were included in this cohort. The cumulative mortality of underweight, normal-weight, and overweight were 2.4/100 person-years (95% CI 1.9–2.9), 1.1/100 person-years (95% CI 0.9–1.3), and 0.5/100 person-years (95% CI 0.1–0.9), respectively. Cumulative mortality was lower in both the normal-weight and overweight populations than in the underweight population, with an adjusted hazard ratio ( AHR ) of 0.5 (95% CI 0.4–0.7, p < 0.001) and 0.3 (95% CI 0.1–0.6, p = 0.002), respectively. Additionally, in the 1176 patients with available viral load data, there was significant difference between the underweight and normal-weight groups after adjustment for all factors, including viral load ( p = 0.031). This result suggests that HIV-infected patients in Guangxi maintaining a BMI of 19–28 kg/m 2 , especially 24–28 kg/m 2 , have a reduced risk of death.

Development and validation of a prognostic nomogram for predicting the survival of HIV/AIDS adults who received antiviral treatment: a cohort between 2003 and 2019 in Nanjing

“…In recent years, many researchers have reported that some laboratory indicators are connected with the survival rate of PLHIV. In this study, CD4, BMI and GLU were signi cantly correlated with the survival rate of PLHIV and showed good consistency with these published studies [10,16,21,26] .…”

Contribution of Adipose Tissue to the Chronic Immune Activation and Inflammation Associated With HIV Infection and Its Treatment

“…Before ART's availability, HIV infected patients with higher BMI showed slower HIV progression compared to underweight patients (128,129), presumably due to delayed wasting/cachexia effects. In ARTtreated patients, obese or underweight patients exhibited higher cumulative mortality rates, delineating an optimal BMI range between 24 and 28 (130) and obesity has been identified as a risk factor for multimorbidity (131). Regarding the impact of obesity on CD4 T cell reconstitution, patients with higher BMI before ART initiation exhibit higher (132,133) or comparable (134) immune reconstitution.…”

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in southwestern China: a cohort study

“…Guangxi, a province in southwestern China, has the second highest number of reported HIV cases in the country, with 703,000 survivals and 40,500 deaths by 2017. The mortality rate (34.3% [4] ) was also higher than the national average mortality rate (23.8%) during the same period. In China, the National Free Antiretroviral Treatment Program (NFATP) began in 2002 and was scaled up in 2003.…”