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Obesity & Weight Gain on Antiretroviral Therapy
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Obesity & Weight Gain on Antiretroviral Therapy
CROI 2019
John R. Koethe
Vanderbilt University Medical Center, Nashville, TN, USA
This talk is a fascinating review of the intersection of weight, food & its processing, poverty, energy expenditure, women & weight gain, geography & the South, comorbidities and other related topics affecting HIV+. Interestingly he discusses lipids & their impact in HIV and associated affects on other metabolic disease & comorbidities, perhaps offering explanations for why HIV+ are at greater risk for metabolic diseases including for one fatty liver and fat changes in HIV+ like belly & lipoatrophy and he talks about mental health as part of this discussion suggesting as I see it a relationship between mental health cognitive impairment in HIV+ and these fat, metabolic & weight perturbations; he says in HIV people develop higher lipid deposits at lower BMI & a younger age and they increase with a greater adiposity. One study at this CROI suggests inflammation might promote weight gain while previously we see weight gain may promote inflammation, this needs investigation Koethe says. At the top of this series of slides I placed a few out of order of presentation to highlight the talk's focus on recent findings & the discussion about integrase inhibitors & weight gain, below the first group of slides they are in the order of sequence - following the presenter Koethe's initial part of his talk which is on obesity & weight gain and its affects immunity & health (associated with inflammation, immune activation, immune disruption) then there is a focus on recent studies looking at weight gain and integrase inhibitors. At the end of the Q&A session following Koethe's talk was a comment & question from Ricky Hsu, an HIV doctor in NYC saying in the context of seeing recent studies regarding seeing weight gain in integrase inhibitors many HIV practitioners are concerned at seeing in some patients extreme anecdotal weight gains of "20-30 pounds" and Koethe said he has seen this too, but we don't yet understand or have studied much the pathophysiology of these extreme weight changes, with Koethe suggesting perhaps there is an effect on the insulin receptor, insulin signaling, and bringing up genetic polymorphisms, and its important to see who is at risk but he added "if this is true" I guess meaning if there really is an association between integrase and weight gain and extreme weight gain. There is 1 study on TAF too which includes a look at integrase inhibitors. Koethe says in his summary slides just below more rigorous studies are needed on angers & weight gain & its impact before changing clinical practice. At this CROI there were a handful of posters on weight gain & integrate which I will report in this series on reports following this slide talk by John Koethe at CROI which reviews the literature on this subject & places the issue of weight gain & immunity into the context of HIV, ARTs, and the recent phenomena regarding integrate inhibitors. He says a 5% increase in weight gain in HIV+ relates to 14% increase in risk for developing diabetes in VA study among vets while a 5% increase in vets without HIV results in only an 8% increased diabetes risk. At the end of the talk during the Q&A a person from the EATG asked about where we go from here, what studies are needed to understand if this weight gain/integrase is real & if so how to understand it: "lowest hanging fruit is clinical trials data....pooled analyses data.....translational science.....putting people with & without HIV on integrase inhibitor & putting them in a metabolic chamber to see how it affects energy expenditure, trying to work out issue of tissue penetration around this & looking at tissue reservoirs". In the end again Koethe emphasized I think to see if these findings are real, we have been wrong before". In the end these questions & issues & discussions highlight & underscore to me a bigger problem that the overall Aging & HIV problem is much more complicated & underestimated than anyone realizes and is much more dangerous to PLWH than anyone realizes.
Jules Levin, NATAP
"Obesity is defined as a BMS >30, Overweight is defined as a BMI of 25 to 30, normal is <25."
webcast: http://www.croiwebcasts.org/console/player/41364?mediaType=slideVideo&
here are several highlights, but read through the slides to see the full slide data and listen to webcast.
StartFragment
I've divided this talk into three parts. The first will be a review of the epidemiology and clinical features of the increasing burden of NCDs in our aging population of HIV+ persons in the United States
The second, a review of major studies on adipose tissue T cells as a potential contributor to metabolic disease,
Lastly, I'll discuss recent studies in this area conduced at Vanderbilt, and the value of single cell immunology, in which Vanderbilt is a national leader, for unravelling questions around adaptive immunology and metabolic disease
EndFragment
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