Rising Obesity Prevalence and Weight Gain Among Adults Starting Antiretroviral Therapy in the United States and Canada

Abstract

The proportion of overweight and obese adults in the United States and Canada has increased over the past decade, but temporal trends in body mass index (BMI) and weight gain on antiretroviral therapy (ART) among HIV-infected adults have not been well characterized. We conducted a cohort study comparing HIV-infected adults in the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to United States National Health and Nutrition Examination Survey (NHANES) controls matched by sex, race, and age over the period 1998 to 2010. Multivariable linear regression assessed the relationship between BMI and year of ART initiation, adjusting for sex, race, age, and baseline CD4+ count. Temporal trends in weight on ART were assessed using a generalized least-squares model further adjusted for HIV-1 RNA and first ART regimen class. A total of 14,084 patients from 17 cohorts contributed data; 83% were male, 57% were nonwhite, and the median age was 40 years. Median BMI at ART initiation increased from 23.8 to 24.8 kg/m2 between 1998 and 2010 in NA-ACCORD, but the percentage of those obese (BMI ≥30 kg/m2) at ART initiation increased from 9% to 18%. After 3 years of ART, 22% of individuals with a normal BMI (18.5–24.9 kg/m2) at baseline had become overweight (BMI 25.0–29.9 kg/m2), and 18% of those overweight at baseline had become obese. HIV-infected white women had a higher BMI after 3 years of ART as compared to age-matched white women in NHANES (p = 0.02), while no difference in BMI after 3 years of ART was observed for HIV-infected men or non-white women compared to controls. The high prevalence of obesity we observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future.

From Wasting to Obesity: The Contribution of Nutritional Status to Immune Activation in HIV Infection

“…In an analysis of >14 000 HIV-infected persons in the United States and Canada, the percentage of patients who were obese at ART initiation increased from 9% to 18% between 1998 and 2010, and 22% of individuals with a normal BMI (18.5-25) at treatment initiation had become overweight after 3 years of ART, and 18% of those overweight at initiation had become obese. Compared with agematched National Health and Nutrition Examination Survey controls from the general population, HIV-infected white women had a higher BMI after 3 years of ART than controls, while no difference in BMI after 3 years of ART was observed for HIV-infected white men, and nonwhite men and women, as compared to controls [2].…”

“…Based on the microbiome profile reported in animal and human studies of excess adiposity, this alteration in the ratio of Bacteroidetes to Firmicutes levels in untreated HIV infection would appear to be protective against obesity. However, many HIV patients gain weight after ART initiation, particularly in the first 12 months, and the potential contribution of microbiome changes after ART initiation to weight gain is an important area for further study [2].…”

“…Following the introduction of effective antiretroviral therapy (ART) in resource-rich, developed countries, the incidence of human immunodeficiency virus (HIV)-associated wasting in advanced disease has declined, while the proportion of overweight and obese HIV-infected individuals receiving longterm treatment has steadily risen [1,2]. In contrast, due to the geographic overlap of high HIV prevalence and chronic food insecurity, new infections in many resource-limited countries frequently occur against a backdrop of chronically insufficient macronutrient intake (hereafter referred to as malnutrition) [3].…”

Prevalência de excesso de peso, obesidade central e risco de comorbidades metabólicas em adultos com HIV/AIDS sem terapia antirretroviral

“…A investigação do excesso de peso e da obesidade abdominal em PVHA é de extrema importância na prática clínica e acompanhamento dos indivíduos infectados pelo HIV, visto que o acúmulo de gordura corporal aumenta o risco de diversas comorbidades metabólicas (21,22) . No Brasil, estudo transversal realizado com o objetivo de investigar a prevalência de sobrepeso e obesidade abdominal em indivíduos portadores de HIV/AIDS em uso de terapia ARV de alta potência, concluiu que 30,5% dos indivíduos apresentaram sobrepeso, sendo que a obesidade abdominal esteve presente em 32,7% das mulheres e 6,4% dos homens (14) .…”

“…Estudo realizado com 14.084 PVHA provenientes de 17 coortes, demonstrou que, após três anos do início da terapia ARV, 22% e 18% dos indivíduos com IMC normal (18,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)9 kg /m 2 ) tinham sido reclassificados com excesso de peso (IMC 25,0-29,9 kg /m 2 ) e obesidade (IMC≥30 kg /m 2 ), respectivamente (23) . O presente estudo utilizou o GAPB (20) O GAPB considera que o consumo diário de, pelo menos, 400g de frutas, legumes e verduras (FVL) é possivelmente a mais importante de todas as diretrizes, pois, além de contribuir para a variedade e oferta de nutrientes, pode colaborar na redução do consumo de alimentos com alto teor de gordura, sal e açúcar (20) .…”