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Obesity Affects Almost One Quarter of HIV-Positive US People in Care in CDC Analysis
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20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
Nearly 25% HIV-positive people in care in the United States are obese, according to analysis of a nationally representative sample by the Centers for Disease Control and Prevention (CDC) [1]. This rate is substantially lower than the 36% obesity prevalence calculated in the general US population, but 40% of HIV-positive women are obese.
Obesity boosts the risk of cardiovascular disease, some non-AIDS cancers, type 2 diabetes, and other conditions [2] that pose a high risk to people with HIV. But obesity prevalence had not been calculated in a US HIV population until this analysis of the CDC's 2009 Medical Monitoring Project.
The Medical Monitoring Project is a national surveillance system including 23 health department jurisdictions across the United States. For this analysis the CDC used the standard definition of obesity, a body mass index above 30 kg/m(2). The investigators age-adjusted obesity prevalence to the 2000 US Census population and compared it with similarly adjusted published obesity estimates from the National Health and Nutrition Examination Survey (NHANES) for 2009-2010.
The analysis included 4040 HIV-positive adults in care, 73% of them men, 26% 20 to 39 years old, 66% 40 to 59 years old, and 8% 60 or older. The study group was 41% non-Hispanic black, 35% non-Hispanic white, and 19% Hispanic. Almost half of the study group, 45%, had a household income below the poverty level, and 23% had less than a grade 12 education. Just over half (54%) had been diagnosed with HIV for 10 years or more. Almost everyone (95%) was taking antiretroviral therapy, and 61% had a viral load below 200 copies. Nearly half of the study group (47%) were men who have sex with men, 24% were men who have sex with women, and 26% were women who have sex with men.
Age-adjusted obesity prevalence among people with HIV stood at 22.8%, compared with 35.7% in the general-population NHANES group. Age-adjusted obesity prevalence was higher in women with HIV than in general-population women (40% versus 36%) but sharply lower in men with HIV than in general-population men (17% versus 36%). Among HIV-positive women under 40 years old, 45% were obese.
For all HIV-positive people, obesity prevalence was higher in the youngest age group and declined with age. In the general-population NHANES sample, obesity prevalence rose with age (see list below). This age-related difference in obesity prevalence was driven by differences in women; the age differences in HIV-positive and general-population men were not significant. Overall, women in the youngest age group had the highest obesity prevalence:
Obesity prevalence by age in HIV group and NHANES:
HIV group (linear trend for age P < 0.01):
20-39: 26.5%
40-59: 22.1%
60+: 18.6%
General population (NHANES) (linear trend for age P < 0.01):
20-39: 32.6%
40-59: 36.6%
60+: 39.7%
Obesity prevalence by age in women:
HIV group (linear trend for age P < 0.01):
20-39: 44.7%
40-59: 38.2%
60+: 29.5%
General population (NHANES) (linear trend for age P < 0.01):
20-39: 31.9%
40-59: 36.0%
60+: 42.3%
Obesity prevalence by age in men:
HIV group:
20-39: 17.4%
40-59: 16.6%
60+: 15.2%
General population (NHANES):
20-39: 33.2%
40-59: 37.2%
60+: 36.6%
Among people with HIV, logistic regression analysis adjusted for age, race, poverty, years since HIV diagnosis, and durable viral suppression found that women had a twice higher risk of obesity than men. Education and HIV disease stage also independently affected risk of obesity, at the following adjusted prevalence ratios (aPR) (and 95% confidence intervals):
-- Women compared with men: aPR 2.12 (1.87 to 2.41)
-- Less than grade 12 vs bachelor's degree or higher: aPR 1.46 (1.13 to 1.89)
-- Grade 12, GED, or some college vs bachelor's degree or higher: aPR 1.33 (1.07 to 1.65)
-- Stage 2 disease (nadir CD4 200-499) vs stage 3 (AIDS): aPR 1.17 (1.00 to 1.37)
-- Stage 1 disease (nadir CD4 >/= 500) vs stage 3 (AIDS): aPR 1.36 (1.09 to 1.65)
The CDC suggested that weight loss interventions and future research "should pay particular attention to younger women as a high-risk group." They proposed that "comprehensive care of HIV-infected adults should include both prevention and treatment of obesity to reduce morbidity and mortality from adverse long-term outcomes including cardiovascular disease and certain cancers."
References
1. Thompson-Paul A, Wei S, Mattson C, Skarbinski J. Prevalence of obesity in a nationally representative sample of HIV+ adults receiving medical care in the US: Medical Monitoring Project, 2009. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 777.
2. Centers for Disease Control and Prevention. Overweight and obesity. Causes and consequences. http://www.cdc.gov/obesity/adult/causes/index.html
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