 |
|
|
| |
Obesity and Inflammation in Resource-Diverse Settings of Antiretroviral Therapy Initiation
|
| |
| |
Reported by Jules Levin
CROI 2015
Feb 23-26, Seattle, WA
Kristine M. Erlandson1, Nikhil Gupte2, Javier R. Lama3, Patcharaphan Sugandhavesa4, Thando Mwelase5, Ashwin Balagopal2, David Asmuth6, Thomas B. Campbell1, Amita Gupta2 1University of Colorado-Anschutz Medical Campus, Aurora, CO, USA; 2 Johns Hopkins University, Baltimore, MD, USA; 3 Impacta Peru Clinical Trials Unit, Lima, Peru; 4 Chiang Mai University, Chiang Mai, Thailand; 5 University of Witswatersand, Johannesburg, South Africa; 6 University of California Davis, Sacramento, CA, USA.
......."Among HIV-infected persons initiating ART in resource-diverse settings (US/Africa/So America/Asia), weight gain among underweight persons may reduce inflammation. In contrast, weight gain among obese persons appeared to heighten inflammation. As sCD14 is a marker of mortality during HIV treatment, the data highlight the potential impact of obesity on treatment outcomes - from Jules: but in the USA 0% were underweight (BMI <18.5 kg/m2 and 58% were overweight: BMI >25 kg/m2), the remainder 42% were normal 18.5-25 kg/m2......for example, if a person is 25 yo, 5 ft 6 inches tall and 130 pounds in weight the BMI is 20.98 kg/m2, considered within normal range"...... so in the end I'm not sure how much these study results apply in the USA regarding underweight individuals but certainly for overweight/obese patients we know from many studies that obesity increases inflammation & is a contributor to comorbidities developing
Reported by Jules Levin
CROI 2015
Feb 23-26, Seattle, WA
Kristine M. Erlandson1, Nikhil Gupte2, Javier R. Lama3, Patcharaphan Sugandhavesa4, Thando Mwelase5, Ashwin Balagopal2, David Asmuth6, Thomas B. Campbell1, Amita Gupta2 1University of Colorado-Anschutz Medical Campus, Aurora, CO, USA; 2 Johns Hopkins University, Baltimore, MD, USA; 3 Impacta Peru Clinical Trials Unit, Lima, Peru; 4 Chiang Mai University, Chiang Mai, Thailand; 5 University of Witswatersand, Johannesburg, South Africa; 6 University of California Davis, Sacramento, CA, USA.
from Jules: CRP is an inflammation marker, a decrease is good, an increase in sCD14 is not good
program abstract-
Background: The heightened inflammatory profile resulting from both HIV infection and obesity is of increasing importance in many HIV-related comorbidities. Little is known about the association between the change in body mass index (BMI) with antiretroviral (ART) initiation and the change in inflammatory markers, particularly in resource-limited settings.
Methods: AIDS Clinical Trials Group study A5175 was a randomized trial comparing 3 ART regimens in resource-diverse international settings; the following is a country stratified random sub-cohort of 270 subjects; 246 subjects had stored samples. BMI (weight [kg]/height [m]2) was categorized as underweight (UW, 10 HIV-1 RNA, and treatment arm. A separate model assessed the effect of change to OB BMI (>30 versus ≤30).
Results: Of 246 participants, 50% were female, 53% black, with a median age 35 and CD4 count 179. 37% were assigned to ZDV/3TC+EFV, 33% to ATV+FTC+DDI, and 30% to TDF/FTC+EFV. At week 0, 8% were UW, 65% NW, 27% OW/OB including 7% OB; at week 48, 3% were UW, 60% NW, 37% OW/OB including 9% OB. In multivariate analyses, among baseline UW subjects, an incremental BMI increase was associated with decreased CRP (ß -9.32; p=0.001) and trend towards decreased sCD14 (ß -0.09; p=0.09). For baseline OW/OB subjects, an increase in BMI was associated with increased sCD14 (ß 0.02; p=0.05). No significant associations were detected in the NW group or within other inflammatory markers (p>0.05). In multivariate analyses comparing OB vs not OB participants, OB was associated with an increase in sCD14 (ß 0.19; p=0.02) and trend towards higher IL-18 (ß 127.7; p=0.056); there were no associations with other markers.
Conclusions: Among HIV-infected persons initiating ART in resource-diverse settings, weight gain among underweight persons may reduce inflammation. In contrast, weight gain among obese persons appeared to heighten inflammation. As sCD14 is a marker of mortality during HIV treatment, the data highlight the potential impact of obesity on treatment outcomes. Further investigation into the impact of obesity on HIV treatment outcomes in resource-limited settings is needed.
|
| |
|
|
|
|
|
