Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV

Abstract

Objectives We conducted a longitudinal cohort analysis to evaluate the association of pre‐treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV). Methods Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated‐measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds. Results Of 4993 PLHIV (66% male), 62% had pre‐treatment BMI in the normal range (18.5–25.0 kg/m2), while 26%, 10% and 2% were underweight (< 18.5 kg/m2), overweight (25–30 kg/m2) and obese (> 30 kg/m2), respectively. Both higher baseline and time‐updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23–27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9–28.3] and 28.8 cells/µL (95% CI: 6.6–50.9), respectively, compared with normal BMI (18.5–23 kg/m2). PLHIV with BMIs of 25–30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10–1.47) and 1.61 times (95% CI: 1.13–2.24) more likely to develop CVD risk factors. No relationship between pre‐treatment BMI and VF was observed. Conclusions High pre‐treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.

High baseline body mass index predicts recovery of CD4+ T lymphocytes for HIV/AIDS patients receiving long-term antiviral therapy

“…We found that the higher the baseline BMI was, the better the effect of immune reconstitution was for patients undergoing ART. The gain in CD4+ T cells increased with baseline BMI, and with a longer follow-up, the gain in CD4+ T cells in obese patients changed significantly [24,25]. CD4+ T cells continued to increase with the length of follow-up, especially in the first year, when the rate of CD4+ T-cell growth was most significant, a finding that is consistent with other studies [26,27].…”

“…Similarly, an observational cohort study at a clinic affiliated with Vanderbilt University in Nashville, USA [15] concluded that there is an optimal BMI range for immune reconstitution in patients receiving ART, with patients with a baseline BMI of 25-30 kg/m 2 achieving the greatest CD4+ T-cell gain at month 12, above which CD4+ T-cell gain decreases. In contrast, a cohort analysis of PLHIV from the Asia-Pacific region [24] found that compared with normal BMI (18.5-23 kg/m 2 ), patients with a BMI >27.5 kg/m 2 at baseline had a 28.8 cell/μL (95% CI: 6.6, 50.9 cell/μL) increase in CD4+ cell count. In addition, we also explored the association between BMI and immune recovery to the threshold in patients with baseline CD4+ T-cell counts <200 cells/μL and concluded that higher baseline BMI supported immune recovery to the threshold (CD4+ T cells � 350 cells/μL, �500 cells/μL) during follow-up.…”

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

“…It has been shown that patients with high pre-treatment body mass index (BMI) have a substantial gain in CD4 + T lymphocyte recovery independently [41,42]. This may be because BMI contributes to some extent to drug metabolism, thus affecting the e cacy of cART.…”

Dysregulation of memory B cells and circulating T follicular helper cells is a predictor of poor immune recovery in HIV‐infected patients on antiretroviral therapy

“…Poor immune recovery represents a major obstacle for HIV‐infected patients to achieve a functional cure 3,6 . The difficulties in fully understanding and overcoming this problem are mainly associated with the wide range of direct and indirect risk factors that contribute to poor immune recovery, including but not limited to a high body mass index, older age, low thymus output, coinfection, and abnormal gut bacterial metabolism 22–28 …”

“…3,6 The difficulties in fully understanding and overcoming this problem are mainly associated with the wide range of direct and indirect risk factors that contribute to poor immune recovery, including but not limited to a high body mass index, older age, low thymus output, coinfection, and abnormal gut bacterial metabolism. [22][23][24][25][26][27][28] The role of Tfh cells and their interaction with B cells within germinal centers has been described in the last decade. Despite some controversy, most researchers agree that a high frequency of Tfh in incomplete reconstitution of CD4 + T cells in HIV-infected patients.…”