Obesity Is Associated with Race/Sex Disparities in Diabetes and Hypertension Prevalence, But Not Cardiovascular Disease, Among HIV-Infected Adults

Abstract

Race/sex differences are observed in cardiometabolic disease (CMD) risk and prevalence in the context of treated, chronic HIV infection, and these differences could be exacerbated by disparities in obesity prevalence. We sought to determine the effect of obesity on these disparities among people living with HIV. Prevalence of CMD (dyslipidemia, cardiovascular disorders, hypertension, diabetes, chronic kidney disease) was determined for patients seen at the University of Alabama at Birmingham HIV clinic between 7/2010 and 6/2011. Staged logistic regression was used to examine the impact of race/sex on comorbidities adjusting for key confounders including/ excluding obesity (body mass index ‡30 kg/m 2 ). Of 1,800 participants, 77% were male, 54% were black, and 25% were obese. Obesity prevalence differed by race/sex: black women 49%, black men 24%, white women 24%, white men 15% ( p < 0.01). Compared to white men, other groups had reduced odds for dyslipidemia and cardiovascular disorders ( p < 0.01). Black men had increased odds for hypertension and chronic kidney disease, while black women had a nearly 2-fold increased odds for diabetes and hypertension (all at p < 0.01). The associations of black women with diabetes and hypertension were attenuated when obesity was included in the models. Other group differences remained significant. Disparities in obesity prevalence do not explain race/sex differences in all CMD among people with HIV. Obesity accounted for associations with diabetes/hypertension for black women, who may benefit from weight reduction to decrease disease risk. Further investigations into the etiology and treatment of CMD in people living with HIV should consider unique race/sex treatment issues.

Monocyte bioenergetic function is associated with body composition in virologically suppressed HIV-infected women

“…In previous work by our group and others, obesity contributes to the excess prevalence of cardiometabolic diseases, and obesity and excess adiposity more commonly affect women than men [6], [7], [8]. Black women in particular have a 2-fold increase in hypertension and diabetes compared to other groups, an association that was attenuated after adjusting for obesity [8]. Our data confirm previous reports that women living with HIV (WLH) are more likely to be obese than men and at particular risk for poor health outcomes related to obesity [7], [9], [10].…”

“…Unfortunately, chronic HIV infection is associated with excess risk for cardiometabolic diseases including diabetes, hypertension, dyslipidemia, and atherosclerosis [1], [2], [3], [4], [5]. In previous work by our group and others, obesity contributes to the excess prevalence of cardiometabolic diseases, and obesity and excess adiposity more commonly affect women than men [6], [7], [8]. Black women in particular have a 2-fold increase in hypertension and diabetes compared to other groups, an association that was attenuated after adjusting for obesity [8].…”

Alcohol and dietary factors associate with gut integrity and inflammation in HIV‐infected adults

“… After initiating ART, approximately one‐third to one‐half of HIV‐infected adults are overweight or obese, and obesity is more prevalent in HIV‐infected women than in HIV‐infected men. Our data, when examined in conjunction with this evidence, suggest that structured, evidence‐based interventions designed to lower carbohydrate and increase protein consumption may help to mitigate the rising obesity epidemic in HIV‐infected adults.…”

Cardiovascular disease in women living with HIV: A narrative review

“…[13] Seven studies investigating CVD incidence and prevalence in mixed-sex cohorts, all found increased cardiovascular events in HIV-positive men when compared to WLHIV. [14][15][16][17][18][19][20] However, the three that compared these data to data from HIV-negative populations (one using an HIV-negative comparison group, the other two referring to general population data) found that the increased prevalence of cardiovascular events seen among PLWH was more pronounced in female study participants, suggesting that the increased risk of CVD conferred by HIV may be even higher in women. [15,17,19] 3.2 Pathogenesis of CVD in women living with HIV In studies directly comparing HIV-positive men and women, men have been found to be at greater risk of increased carotid intimal thickness (cIMT) and coronary artery stenosis ( Table 2).…”

“…Eleven studies assessed the prevalence of traditional CVD risk factors (such as hypertension, diabetes mellitus and obesity) among WLHIV (Table 3). [16,[34][35][36][37][38][39][40][41] Studies conducted in a variety of geographical regions found that WLHIV were significantly more likely to have a raised body mass index when compared to HIV-positive men, [37,39,41] or HIV-negative women. [30] Metabolic syndrome (MS) also appears to be more prevalent in WLHIV, with studies from Uganda and France finding an association between female gender and MS. [35,39] Seven studies investigated the Framingham Risk Score (FRS) scores of people living with HIV, with differing results.…”