 |
|
|
| |
HIV & Aging: Overweight & Hypertension Increasing
|
| |
| |
IDSA Conference in San Diego
From 10/4/07 to 10/7/07
Abstracts follow article below.
At a Glance
• The majority of people with HIV are overweight, just like the rest of the U.S. population, suggests a study.
• Excessive weight loss - known as wasting - once was a major problem among people with HIV/AIDS, but now the problem is weight gain: most people in the study gained weight over the course of the infection.
• 63 percent of HIV-positive people in the study were overweight or obese, compared to 66 percent of the overall population.
• Another study found that older people with HIV who were on HAART were no more likely to have heart disease or diabetes than those without the virus, suggesting the therapy is not as toxic as once thought. (I question some of this!!!)
HIV-POSITIVE PEOPLE NOW OVERWEIGHT LIKE EVERYONE ELSE
As Disease Becomes a Chronic Condition, Other Health Issues Arise
SAN DIEGO (October 04, 2007) - SAN DIEGO - While the hallmark of HIV/AIDS used to be excessive weight loss, people with the virus now are becoming overweight and even obese right along with the rest of America, suggests research being presented at the 45th Annual Meeting of the Infectious Diseases Society of America (IDSA).
Excess weight loss known as wasting was once a telltale sign of HIV/AIDS. However, in a study of more than 600 HIV-positive people treated at two U.S. Navy clinics, none met the strictest definition of wasting, while 63 percent were overweight or obese.
That is right in line with Americans in general, 66 percent of whom are overweight or obese, according to the Centers for Disease Control and Prevention (CDC).
"In the 1980s, the longer people had HIV, the more wasting they had, but now the longer people have it, the more likely they are to gain too much weight," said Nancy Crum-Cianflone, MD, MPH, lead author of the study and HIV research physician with the TriService AIDS Clinical Consortium, San Diego. "Doctors have been caught up in saving people's lives and keeping opportunistic infections at bay, but today those rates are low and people are living longer. Now we need to start focusing on regular health issues like cancer prevention, blood pressure control, and excess weight gain."
Being overweight may be more likely among those whose disease is being managed successfully . The CDC estimates that as many as a third of HIV-positive people are not in care.
Another study from Washington University School of Medicine in St. Louis suggests that while older HIV-positive people on highly active antiretroviral therapy (HAART) are more likely to have high blood pressure than people without the disease, they have the same incidence of heart disease and diabetes, suggesting that the therapy may not be as harmful as once thought.
U.S. Navy Study: HIV and the Overweight/Obesity Epidemic
The U.S. Navy conducted a study that focused on 663 HIV-positive patients being treated at either the Naval Medical Center in San Diego or the National Naval Medical Center in Bethesda, Md. Of those, 20 (3 percent) met the loosest definition for wasting (body mass index or BMI of 20 percent or less) and none met the stricter definition (BMI of 18.5 or less), while 419 (63 percent) were overweight or obese: 46 percent of the total were overweight (BMI of 25 or more) and 17 percent were obese (BMI of 30 or more). At diagnosis, only 46 percent were overweight or obese, and over the course of the infection, 72 percent gained weight. Of people with full-blown AIDS, 29 percent were overweight or obese.
Those who were younger when diagnosed with HIV or had a longer duration of HIV infection were more likely to gain weight. The study found that those with a high CD4 count (which suggests that the immune system is strong and fighting the disease) were more likely to be overweight.
The study found the use of HAART was not related to the likelihood of weight gain.
Although the study did not assess why people with HIV are gaining weight, there are several possibilities, said Dr. Crum-Cianflone.
"Because a lot of people equate HIV with wasting, it could be that many with the disease are concerned that others will be able to tell they are HIV positive if they're too thin, so they make it a point to gain weight when they're diagnosed," she said. "Also, the general U.S. population is gaining weight, and people with HIV are doing the same now that the disease essentially has become a chronic condition."
Dr. Crum-Cianflone says the findings are especially intriguing because most of the people in the study are or were in the military, and studies show that military personnel are more likely to be in shape than the general population.
"This suggests we need to think about screening HIV-positive patients for weight gain, calculating body mass index and putting them in prevention and education programs," she said.
Disclaimer: The views expressed in this report are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.
Washington University Study: HAART and an Aging Population
A Washington University School of Medicine study compared the incidence of several conditions among 70 older HIV- positive patients (90 percent of whom were taking HAART) to a control group of 70 people without the disease, who were matched for age (an average of 56), race, gender, smoking habits, and BMI. In the HIV-positive group, seven (10 percent) had heart disease, compared to 10 (14 percent) of the control group; nine (13 percent) had diabetes, compared to eight (11 percent) among the control group. However, 36 (51 percent) of those with HIV had high blood pressure, compared to 22 (31 percent) of the control group. Also levels of triglycerides - a type of fat in blood - tended to be higher in those with HIV.
In the study, 52 percent of HIV-positive patients were overweight or obese.
"Earlier studies have shown that people on HAART have a higher risk of heart attack, but we didn't see that," said Nur Onen, MD, lead author of the study and an infectious diseases fellow at Washington University School of Medicine. "But those studies looked at younger people, and those in our study were over 50, and were on therapy for an average of seven years."
More studies are needed to determine whether HAART has an effect on blood pressure, she said.
The study found no differences between the two groups in either cognitive deficits or osteoporosis. Numerous studies have found that HIV-positive people on HAART are at higher risk for osteoporosis, but this study was the first to look at that issue in older people. More research needs to be done, but the findings are reassuring and suggest that perhaps that risk levels off as people are on HAART longer, said Dr. Onen.
"HAART is probably not as toxic as people once believed," she said. "People are doing so well on HIV medication we need to start looking at other health issues."
Co-authors of the study being presented at IDSA by Dr. Crum-Cianflone are: Raechel Tejidor, Sheila Medina, Irma Barahona, and Anuradha Ganesan.
Co-authors of the study being presented at IDSA by Dr. Onen are: W. Seyfried, E.T. Overton, and Kristin Mondy, MD.
ABSTRACT 1028
Obesity among HIV Patients: The Latest Epidemic
NANCY F. CRUM-CIANFLONE, MD MPH1, RAECHEL TEJIDOR, MPH1,
SHEILA MEDINA, MPH1, IRMA BARAHONA, RN2, ANURADHA GANESAN, MD2, on Behalf of the Infectious Disease Clinical Research Program, USUHS, Bethesda, MD; 1Naval Medical Center San Diego, San Diego, CA,2National Naval Medical Center, Bethesda, MD.
Background: Although adequate weight and nutritional status are associated with improved survival among HIV-infected persons, being overweight or obese may contribute to metabolic syndrome and cardiovascular disease. Few data exists on the incidence and predictors of obesity among HIV patients.
Methods: We determined the rates and predictors of obesity among HIV patients at two large military clinics. Data collected included demographics, duration of HIV infection, CD4 count, HIV viral load, antiretroviral therapy, diabetes, and hypertension. Weight categories were a body mass index (BMI) <20 kg/m2 as wasting, 25.0-29.9 overweight, and >30 obese. Statistical analyses included independent samples t-tests and linear regression models.
Results:
63% (419/663) of patients were overweight (46%) or obese (17%); only 3% met the definition of wasting. The mean age of the cohort was 41.0 years (range 20-73), 50% Caucasian; 26% were hypertensive and 8% diabetic.
There were significantly more patients who are currently overweight/obese than at the time of HIV diagnosis (63% vs. 49%, p<0.001). Over the course of HIV infection, 72% gained weight (mean 12.8 lbs).
Increasing BMI was associated with a younger age at HIV diagnosis (OR 1.10, p<0.001), longer duration of HIV (OR 1.10, p=0.02), and hypertension (OR 3.06, p=0.039) in the multivariate model.
Predictors for elevated BMI at the last visit included a high CD4 count (OR=1.23 for each 100 cells/mm3, p<0.001) and hypertension (OR=8.31, p<0.001). No relationship with specific antiretroviral regimens was found.
Conclusion: 65% of patients in our cohort are overweight or obese, a higher rate than previously described among HIV patients and greater than expected given the relatively young, healthy population evaluated. Many patients were already obese or overweight at time of HIV diagnosis, but 72% gained weight during their HIV infection. Screening and preventive measures for obesity among HIV patients are needed.
ABSTRACT 1100
Effects of HIV and Highly Active Antiretroviral Therapy in an Aging
Outpatient Population
N. F. Onen, W. Seyfried, E. T. Overton, K. Mondy; Washington University
School of Medicine, St. Louis, MO.
Background: The effect of longer duration of HAART and advanced age in HIV+ persons is poorly studied.
Methods: Prospective study of HIV+ outpatients, aged > 50 years. Clinical, fasting laboratory, DEXA, and cognitive data (assessed by Digit Symbol Substitution Test) were collected on all subjects and compared to controls from NHANES matched by age, race, gender, smoking status, and body mass index (BMI). Comparison between groups was performed by _2, t-test, or Mann- Whitney U test where appropriate.
Results:
70 HIV+ subjects participated: 86% male, 66% Caucasian, mean age 56 years, mean BMI 25 kg/m2, 39% current smokers. 90% of HIV+ subjects were on HAART (mean time 7 years, 91% full viral suppression).
Compared to controls, HIV+ subjects had higher prevalence of hypertension (51% vs. 31%), while the respective prevalence of ischemic heart disease (10% vs. 9%) and diabetes (13% vs. 7%) did not differ between groups.
HIV-infected subjects had mean higher triglyceride levels, lower LDL and lower glucose levels than controls (all p<0.05). However, insulin resistance (HOMA-IR) was comparable. 10-year risk for coronary heart disease (Framingham risk scores) were similar; 10% in men and 3% in women. There was a nonsignificant
increase in chronic renal disease among HIV+ vs. control subjects (11% vs. 6%).
Osteoporosis was present in 6% of each group and cognitive testing results were similar.
Conclusion: In this small cohort of HIV+ older persons on long-term HAART, a high rate of virologic suppression and low prevalence of metabolic and cognitive complications was observed. Overall, HIV+ subjects had a similar risk of those complications compared to healthy controls. Larger studies are warranted.
|
| |
|
|
|
|
|
