Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens
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. PWH aged ≥18 years were included who started a new antiretroviral (baseline) durin...
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| Published in: | AIDS (London) Vol. 36; no. 15; p. 2107 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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01.12.2022
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| ISSN: | 1473-5571, 1473-5571 |
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| Abstract | 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.
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.
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.
A BMI increase was associated with DM and a decrease associated with death. |
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| AbstractList | 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.BACKGROUNDWeight 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.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.METHODSPWH 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.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.RESULTS6721 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.A BMI increase was associated with DM and a decrease associated with death.CONCLUSIONSA BMI increase was associated with DM and a decrease associated with death. 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. 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. 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. A BMI increase was associated with DM and a decrease associated with death. |
| Author | Rasmussen, Line D Clarke, Amanda Reekie, Joanne Portu, Joseba J Mocroft, Amanda Peters, Lars Mast, T Christopher Gisinger, Martin Milinkovic, Ana Gerstoft, Jan Staub, Thérèse Zagalo, Alexandra de Wit, Stéphane Bannister, Wendy P Hadziosmanovic, Vesna Lacombe, Karine Borodulina, Elena Calmy, Alexandra Wiese, Lothar Cavassini, Matthias Schommers, Philipp Tau, Luba |
| Author_xml | – sequence: 1 givenname: Wendy P surname: Bannister fullname: Bannister, Wendy P organization: Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – sequence: 2 givenname: T Christopher surname: Mast fullname: Mast, T Christopher organization: Merck & Co., Inc., Kenilworth, New Jersey, USA – sequence: 3 givenname: Stéphane surname: de Wit fullname: de Wit, Stéphane organization: CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium – sequence: 4 givenname: Jan surname: Gerstoft fullname: Gerstoft, Jan organization: Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark – sequence: 5 givenname: Lothar surname: Wiese fullname: Wiese, Lothar organization: Sjællands Universitetshospital, Roskilde, Denmark – sequence: 6 givenname: Ana surname: Milinkovic fullname: Milinkovic, Ana organization: Chelsea and Westminster Hospital, London, UK – sequence: 7 givenname: Vesna surname: Hadziosmanovic fullname: Hadziosmanovic, Vesna organization: University Clinical Centre Sarajevo, Clinic for Infectious Diseases, Sarajevo, Bosnia and Herzegovina – sequence: 8 givenname: Amanda surname: Clarke fullname: Clarke, Amanda organization: University Hospitals Sussex NHS Foundation Trust and Brighton & Sussex Medical School, Brighton, UK – sequence: 9 givenname: Line D surname: Rasmussen fullname: Rasmussen, Line D organization: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark – sequence: 10 givenname: Karine surname: Lacombe fullname: Lacombe, Karine organization: Sorbonne Université, IPLESP Inserm UMR-S1136, AP-HP, Paris, France – sequence: 11 givenname: Philipp surname: Schommers fullname: Schommers, Philipp organization: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany – sequence: 12 givenname: Thérèse surname: Staub fullname: Staub, Thérèse organization: Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg – sequence: 13 givenname: Alexandra surname: Zagalo fullname: Zagalo, Alexandra organization: Santa Maria University Hospital, Department of Infectious Diseases, Lisbon, Portugal – sequence: 14 givenname: Joseba J surname: Portu fullname: Portu, Joseba J organization: Hospital Universitario de Alava, Vitoria-Gasteiz, Spain – sequence: 15 givenname: Luba surname: Tau fullname: Tau, Luba organization: Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel – sequence: 16 givenname: Alexandra surname: Calmy fullname: Calmy, Alexandra organization: HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland – sequence: 17 givenname: Matthias surname: Cavassini fullname: Cavassini, Matthias organization: Centre hospitalier Universitaire Vaudois, Lausanne, Switzerland – sequence: 18 givenname: Martin surname: Gisinger fullname: Gisinger, Martin organization: University Hospital Innsbruck, Innsbruck, Austria – sequence: 19 givenname: Elena surname: Borodulina fullname: Borodulina, Elena organization: Samara State Medical University, Samara, Russia – sequence: 20 givenname: Amanda surname: Mocroft fullname: Mocroft, Amanda organization: Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK – sequence: 21 givenname: Joanne surname: Reekie fullname: Reekie, Joanne organization: Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark – sequence: 22 givenname: Lars surname: Peters fullname: Peters, Lars organization: Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark |
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| SubjectTerms | Adolescent Adult Anti-Retroviral Agents - therapeutic use Body Mass Index Cardiovascular Diseases - complications Diabetes Mellitus - epidemiology Female HIV Infections - complications HIV Infections - drug therapy Humans Male Middle Aged Neoplasms - complications Neoplasms - drug therapy Neoplasms - epidemiology Obesity - drug therapy Overweight - complications Overweight - drug therapy Overweight - epidemiology Risk Factors |
| Title | Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens |
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