Antiretrovirals Not Causing Weight Gain in People with HIV

Overweight and obesity in people with HIV are linked to behavioral factors and longer lives, not adverse effects of antiretroviral therapy, according to a new study.

Isabelle Poizot-Martin, MD

Researchers attribute the increasing number of persons with HIV infections who are overweight to behavioral factors and living longer, rather than to an adverse effect of antiretroviral treatment.

Isabelle Poizot-Martin, MD, Immuno-hematology Unit, APHM-Sainte Marguerite Hospital, Marseille, France and colleagues note that while patients with HIV are living longer because of effective treatments, comorbidities are emerging earlier and more frequently.

Although noting that metabolic and cardiovascular diseases are now the 2nd leading causes of death for persons with HIV in high-income countries, Poizot-Martin and colleagues state, "few studies have investigated the factors associated with overweight and obesity in HIV-infected people."

The researchers conducted a cross-sectional study in a cohort of 862 patients attending an HIV outpatient unit in 2015. They analyzed data including demographic characteristics, behavioral factors such as alcohol consumption and smoking, comorbidities, CD4+ and CD8+ T cell counts, and duration of HIV suppression. The antiretroviral treatments were assessed for the particular agents and whether administered to treatment naive persons, or as previous or ongoing treatment.

Definitions of obesity and overweight corresponded to the World Health Organization (WHO) parameters of body mass index (BMI) ≥30kg/m2 and ≥25kg/m2, respectively; and the association of BMI to other variables was analyzed for 3 classes: obese, overweight, or not overweight.

The researchers reported finding 22.2% of the cohort were overweight, 5.3% were obese, with prevalence increasing with age, and 7.5% were underweight, with BMI <18.5 kg/m2. At least 1 comorbidity was found in 35.8%, and 42.7% of this sub-group were overweight or obese.

Poizot-Martin and colleagues found no association between being overweight or obese with the antiretroviral regimens or immune cell counts. Instead, these were associated with age, HIV follow-up duration, and HIV transmission risk group, as well as gender and HCV status. In those with substance use data available, overweight was also associated with alcohol consumption and nonsmoking status.

"Therefore, risk factors for excessive weight gain other than cART (combined antiretroviral therapy) should be monitored to avoid an over-risk of comorbidities in the HIV-infected population," Poizot and colleagues recommended.

Others observing body fat increases soon after antiretroviral therapy is started are not dismissing a direct association, however.

Saverio Stranges, MD, PhD, Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg, and colleagues conducted a meta-analysis of studies looking at body fat changes in patients with HIV comprising over 53,000 participants.

Stranges and colleagues associated the antiretroviral therapy with significant increases in BMI, overweight, and obesity among patients with CD4+ counts <350 cells/mm3, but not among those with higher counts.

"Overall, exposure to antiretroviral therapy was associated with increased risk of generalized and central obesity, and risks may be exacerbated by lower CD4+ counts," Stranges and colleagues concluded.

Both groups concur, however—regardless of whether weight gain is directly associated with treatment or to treatment-enabled longer life—that weight management and obesity prevention programs have a place in routine HIV care.

The study, “Risk factors associated with overweight and obesity in HIV-infected people,” was published in Medicine.