Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens

Abstract

Background: Weight gain is becoming increasingly prevalent amongst people with HIV (PWH) receiving contemporary antiretroviral treatment. We investigated BMI changes and clinical impact in a large prospective observational study.Methods: PWH aged !18 years were included who started a new antiretroviral (baseline) during 2010-2019 with baseline and !1 follow-up BMI assessment available. Rates of clinical outcomes (cardiovascular disease [CVD], malignancies, diabetes mellitus [DM] and all-cause mortality) were analysed using Poisson regression to assess effect of time-updated BMI changes (>1 kg/m 2 decrease, AE1 kg/m 2 stable, >1 kg/m 2 increase), lagged by 1-year to reduce reverse causality. Analyses were adjusted for baseline BMI plus key confounders including antiretroviral exposure.Results: 6721 PWH were included; 72.3% were male, median age 48 years (interquartile range [IQR] 40-55). At baseline, 8.4% were antiretroviral-naive, and 5.0% were underweight, 59.7% healthy weight, 27.5% overweight, and 7.8% were living with obesity. There was an 8.2% increase in proportion of overweight and 4.8% in obesity over the study period (median follow-up 4.4 years ).

Incident diabetes in course of antiretroviral therapy

“…The incidence we found is in agreement with the estimate of a large meta-analysis reporting data on PWH [34]; however, the incidence of DM is heterogeneous in the literature [4,7,16–22,35–40], with notable differences likely due to the different characteristics of the participants in terms of sex, age, weight, HIV duration, and diabetes ascertainment methodology. Of note, in our study, the mean weight gain was moderate, 0.7 and 1.3 kg at 1 and 2 years, probably explaining why weight gain did not associate with increased risk of DM, contrary to expectations [4,7,35,41]. On the other hand, this feature may be important in assessing the impact of ART but also of other factors and comorbidities, in a context of moderate weight gain, far from that described in some large non-European studies, whose results are not always exportable to other cultural and social contexts [16,42].…”

Changes in body mass index, weight, and waist-to-hip ratio over five years in HIV-positive individuals in the HIV Heart Aging Study compared to the general population

“…While this increase in body weight with the initiation of ART is seen as a "return to health", especially in patients with advanced disease [12], excessive weight and bodymass-index (BMI) increase in some individuals receiving contemporary ART may lead to obesity. BMI increase can be associated with insulin resistance (IR), hyperglycemia, and new-onset diabetes mellitus, [13][14][15]. Initiating ART with or switching to second generation integrase strand transfer inhibitors (INSTIs) and/or tenofovir alafenamide (TAF) has shown to be associated with more pronounced weight and BMI increases [8][9][10][16][17][18].…”

Changes in body mass index, weight, and waist-to-hip ratio over five years in HIV-positive individuals in the HIV Heart Aging Study compared to the general population

“…There are four categories of BMI that were established by the WHO in 1993: underweight, normal, overweight, and obese [14]. BMI increase can be associated with insulin resistance (IR), hyperglycemia, and new-onset diabetes mellitus type II, [15][16][17]. Initiating ART with or switching to second generation integrase strand transfer inhibitors (INSTIs) and/or tenofovir alafenamide (TAF) has shown to be associated with more pronounced weight and BMI increases [8][9][10][18][19][20].…”