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HIV-Positive Adults Continue to Gain Weight on Antiretroviral Therapy

The very treatment that is supposed to help patients infected with the human immunodeficiency virus (HIV) is also leading to weight gain among adults in the United States.

The very treatment that is supposed to help patients infected with the human immunodeficiency virus (HIV) is also leading to weight gain among adults in the United States.

Antiretroviral therapy (ART) combines multiple medicines to inhibit HIV replication. A collaborative analysis found that more and more adults with HIV are gaining weight while on ART. With obesity being a risk factor for a seemingly endless list of health conditions, this is not good news for a population that already has compromised immune systems.

The research compared patients with HIV from the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to healthy controls in the United States National Health and Nutrition Examination Survey (NHANES). From 1998 to 2010, they were matched by sex, race, and age. The total cohort included 14,084 patients from 17 studies — 83% male, 57% nonwhite, and median age of 40.

The median body mass index (BMI) at the beginning of ART increased from 23.8 to 24.8 kg/m² between 1998 and 2010 for those with HIV. Although that does not seem like a major jump, the percentage of patients who were considered obese (defined as a BMI 30 kg/m² or higher) increased from 9% to 18%.

Of the patients who had a normal BMI (18.5 to 24.9 kg/m²) at the start of ART, 22% became overweight (25 to 29.9 kg/m²) after just three years of the treatment. In addition, 18% of individuals who started as overweight became obese after the ART period, as described in AIDS Research and Human Retroviruses.

“HIV-infected white women had a higher BMI after three years of ART as compared to age-matched white women in NHANES, while no difference in BMI after three years of ART was observed for HIV-infected men or non-white women compared to controls,” the authors specified.

It’s already been well-established that patients with HIV are at an increased risk for cardiovascular problems, so the added obesity burden is not helping anyone. The team attributes the ART-weight gain relationship to multiple factors including: lifestyle changes, priorities of care, changes in ART initiation guidelines, and others.

“This is an important piece of the puzzle in the ongoing effort to avoid health complications currently seen in aging HIV-infected populations in North America,” said Thomas Hope, PhD, editor-in-chief of the journal.