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People With HIV Gaining Weight 3 Times
Faster Than HIV-Negatives in US
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
Compared with matched HIV-negative people in the same healthcare system, those with HIV starting antiretroviral therapy (ART) gained body mass index (BMI) more than 3 times faster through 12 years of follow-up [1]. In every baseline (initial) BMI category, people with HIV had faster BMI gains than their HIV-negative counterparts.
Researchers in the Kaiser Permanente healthcare system who conducted this study noted that body weight and composition have posed puzzling questions in HIV populations since the epidemic began. Many recent findings indicate that integrase inhibitors, today's favored antiretrovirals, lead to faster weight gains than other antiretrovirals [2]. The Kaiser group conducted this study to compare changes in BMI between HIV-positive people starting ART and uninfected people in the same healthcare system.
The study involved all HIV-positive people at least 21 years old starting ART in the Kaiser system and with follow-up from 2006 through 2016. Researchers matched them in a 1-to-10 ratio to uninfected people by age, sex, race/ethnicity, clinic, and year. They excluded people with no baseline BMI and people with HIV who started ART before 2006. The Kaiser team used linear mixed-effects models to measure BMI changes over time by HIV status and by HIV status plus baseline BMI. Potential confounders in the analysis were age, race/ethnicity, sex, year, substance use disorders, smoking, census-based education/income, insurance type, and common comorbidities.
The analysis included 8256 people with HIV and 129,966 uninfected controls. Age averaged about 42 in both groups, and about 87% were men. Whites made up about 40% of the whole group, blacks 26%, Hispanics 24%, and Asian/Pacific Islanders 5%. Among people with a known HIV risk, 68% got infected through sex between men, 24% through sex between men and women, and 7% by injecting drugs.
At the first (baseline) study visit, a higher proportion of people with than without HIV had a normal BMI (18.5 to 24.9 kg/m2; 44% versus 24%), similar proportions with and without HIV were overweight (25 to 29.9 kg/m2; 35% and 38%), and a lower proportion with HIV were obese (30+ kg/m2; 18% versus 37%). During follow-up people with HIV had a median of 8 BMI measures, compared with 5 in the control group.
Overall baseline BMI was lower with than without HIV: 25.8 versus 28.7 kg/m2. Through 12 years of follow-up, BMI rose more than 3 times faster in the HIV group (0.22 versus 0.06 kg/m2 per year). By year 12 the HIV group and the control group had similar average BMIs (28.4 and 29.4 kg/m2).
When the researchers compared three groups of HIV-positive and negative people who had similar baseline BMIs (normal/underweight, overweight, or obese), every HIV group gained BMI faster than the corresponding HIV-negative group and ended up with a higher BMI at year 12:
1. Among initially normal/underweight people, through 12 years BMI rose from 21.6 to 25.1 kg/m2 (+0.31 kg/m2 per year) in people with HIV and from 22.0 to 24.2 kg/m2 (+0.20 kg/m2 per year) in people without HIV.
2. Among initially overweight people, through 12 years BMI rose from 26.2 to 28.3 kg/m2 (+0.18 kg/m2 per year) in people with HIV versus from 26.3 to 27.4 kg/m2 (+0.09 kg/m2 per year) in people without HIV.
3. Among initially obese people, BMI rose from 32.6 to 33.5 kg/m2 (+0.07 kg/m2 per year) in the HIV group while falling from 33.5 to 33.2 kg/m2 (-0.02 kg/m2 per year) in the HIV-negative group.
The researchers noted that their findings may not apply strictly to women because men made up a large majority of the study group. They added that BMI is an imperfect measure because it does not account for muscle mass, and they pointed out that their analysis did not consider potentially important unmeasured factors like diet and exercise.
With those limitations in mind, the Kaiser group concluded that "BMI is increasing more rapidly over time for people with HIV, and may soon exceed levels of demographically similar uninfected adults" in the United States. They underlined the critical importance of clarifying the roles of HIV-specific drivers of weight gain, including integrase inhibitors and other antiretrovirals.
References
1. Silverberg M, Leyden W, Alexeeff S, et al. Changes in body mass index over time in persons with and without HIV. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract OAB0603.
2. Bourgi K, Jenkins CA, Rebeiro PF, et al. Weight gain among treatment-naive persons with HIV starting integrase inhibitors compared to non-nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada. J Int AIDS Soc. 2020;23(4):e25484. doi: 10.1002/jia2.25484.
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