Obesity and diabetes in people of African ancestry with HIV

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.

Obesity among women with HIV

“…Several studies have suggested that the modern ART regimens may be the major contributing cause of increasing obesity [1,2,21]. Indeed, WWH experience weight gain with ART initiation, and this weight gain is greater compared to men in several studies [1,12,21,22]. Integrase strand-transfer inhibitor (INSTI)-based ART, specifically, has been associated with increased weight gain especially among WWH [1,2,21,23].…”

“…In contrast, those with greater food insecurity may have lower levels of ART adherence, resulting in higher viral loads, and periods of chronic hunger followed by an increased compensatory consumption of food leading to a 'thrifty phenotype' in future generations [8,30,31]. Lastly, cultural perceptions of a 'healthy' weight may differ considerably among WWH, particularly in many African communities where higher weight may be perceived as more common among people without HIV, persons of greater prosperity, and persons in better health [8,9,[11][12][13]18].…”

“…Among PWH, the association of obesity with metabolic diseases such as type 2 diabetes is well established [1,12,[32][33][34], with women disproportionately impacted by this spectrum of diseases [1,12,32]. A recent study comparing the prevalence of impaired fasting glucose and insulin resistance between both men and women with HIV and the general population found that despite lower rates of obesity in PWH, there were significantly higher rates of impaired fasting glucose and insulin resistance among the PWH [32].…”

“…For example, the proportion of PWH classified as obese at ART initiation in a study of multiple cohorts across North America increased from 9% in 1998 to 18% in 2010 [6,7]. Furthermore, many areas with the highest prevalence of HIV are undergoing a transition to greater urbanization and more energy dense 'Western' dietary patterns, such as South Africa and other Sub-Saharan African nations, accompanied by greater obesity [8][9][10][11][12][13].…”

“…For example, the proportion of PWH classified as obese at ART initiation in a study of multiple cohorts across North America increased from 9% in 1998 to 18% in 2010 [6,7]. Furthermore, many areas with the highest prevalence of HIV are undergoing a transition to greater urbanization and more energy dense ‘Western’ dietary patterns, such as South Africa and other Sub-Saharan African nations, accompanied by greater obesity [8–13]. Among PWH, the high prevalence of obesity is likely due to a combination of factors associated with aging, socioeconomic factors, and, most importantly, possible medication effects from ART.…”