TY - JOUR
T1 - Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens
AU - Bannister, Wendy P
AU - Mast, T Christopher
AU - de Wit, Stéphane
AU - Gerstoft, Jan
AU - Wiese, Lothar
AU - Milinkovic, Ana
AU - Hadziosmanovic, Vesna
AU - Clarke, Amanda
AU - Rasmussen, Line D
AU - Lacombe, Karine
AU - Schommers, Philipp
AU - Staub, Therese
AU - Zagalo, Alexandra
AU - Portu, Joseba J
AU - Tau, Luba
AU - Calmy, Alexandra
AU - Cavassini, Matthias
AU - Gisinger, Martin
AU - Borodulina, Elena
AU - Mocroft, Amanda
AU - Reekie, Joanne
AU - Peters, Lars
AU - EuroSIDA study group
N1 - Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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, ±1 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 [IQR 2.6-6.7]).100 CVDs, 149 malignancies, 144 DMs, and 257 deaths were observed with incidence rates 4.4, 6.8, 6.6, 10.6 per 1000 person-years of follow-up, respectively. Compared to stable BMI, >1 kg/m 2 increase was associated with increased risk of DM (adjusted incidence rate ratio [IRR]: 1.96, 95% confidence interval [CI]: 1.36-2.80) and >1 kg/m 2 decrease with increased risk of death (adjusted IRR: 2.33, 95% CI: 1.73-3.13). No significant associations were observed between BMI changes and CVD or malignancies.CONCLUSIONS: A BMI increase was associated with DM and a decrease associated with death.
AB - 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, ±1 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 [IQR 2.6-6.7]).100 CVDs, 149 malignancies, 144 DMs, and 257 deaths were observed with incidence rates 4.4, 6.8, 6.6, 10.6 per 1000 person-years of follow-up, respectively. Compared to stable BMI, >1 kg/m 2 increase was associated with increased risk of DM (adjusted incidence rate ratio [IRR]: 1.96, 95% confidence interval [CI]: 1.36-2.80) and >1 kg/m 2 decrease with increased risk of death (adjusted IRR: 2.33, 95% CI: 1.73-3.13). No significant associations were observed between BMI changes and CVD or malignancies.CONCLUSIONS: A BMI increase was associated with DM and a decrease associated with death.
KW - Adolescent
KW - Adult
KW - Anti-Retroviral Agents/therapeutic use
KW - Body Mass Index
KW - Cardiovascular Diseases/complications
KW - Diabetes Mellitus/epidemiology
KW - Female
KW - HIV Infections/complications
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasms/drug therapy
KW - Obesity/drug therapy
KW - Overweight/complications
KW - Risk Factors
UR - http://www.scopus.com/inward/record.url?scp=85142400554&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000003332
DO - 10.1097/QAD.0000000000003332
M3 - Journal article
C2 - 35848573
SN - 0269-9370
VL - 36
SP - 2107
EP - 2119
JO - AIDS
JF - AIDS
IS - 15
ER -