Patients with HIV infection who experienced weight gain within the first year of ART initiation were at increased risk for adverse cardiometabolic outcomes.
Antiretroviral therapy (ART) in patients with HIV infection is associated with alterations in weight and body composition within the first year of treatment initiation. These alterations may lead to concurrent changes in metabolic parameters and subsequent cardiometabolic disease, according to study results published in Clinical Infectious Diseases.
Weight gain is common after the initiation of ART and may reduce the risk for mortality in patients with HIV infection who previously had normal to low BMI. However, patients with overweight or obesity at the time of ART initiation do not experience the same mortality benefit.
Researchers conducted a study to investigate the effect of changes in body weight within 1 year of ART initiation on the risk for cardiometabolic disease. The researchers also examined how natal sex, race, and ethnicity affect the relationship between changes in weight and health outcomes. Linear regression models were used to assess the association between changes in weight/waist circumference in weeks 0 to 48 and the change in metabolic parameters in weeks 0 to 48 and weeks 48 to 96. Cox proportional hazards models were used to assess the association between changes in weight/waist circumference in weeks 0 to 48 and the risk for diabetes, metabolic syndrome, cardiometabolic, and cardiovascular events after week 48.
Among 2624 patients included in the final analysis, 81% were men, 60% were non-White, and the median follow-up period was 208 weeks after ART initiation.
The overall mean (SD) weight gain between ART initiation and week 480 was 7.1 (10.7) kg. Women experienced higher weight gain than men at both week 480 (7.3 vs 6.4 kg, respectively) and at week 48 (4.2 vs 3.5 kg, respectively).
Baseline CD4+ counts below 200 cells/µL were significantly associated with body weight gains of more than 10% (hazard ratio [HR], 5.02; 95% CI, 4.23-5.95) and treatment-emergent obesity (HR, 2.76; 95% CI, 2.25-3.39) following ART initiation (both P <.001).
In multivariable models adjusted for baseline BMI and diabetes and hypertension history, the researchers noted that every 1-kg increase in weight from weeks 0 to 48 led to an increase in fasting glucose levels of 0.13 mg/dL (95% CI, 0.001-0.26; P =.05).
In multivariable models adjusted for baseline CD4+ count, nadir CD4+, HIV-1 RNA levels, initial ART drug class, baseline BMI, and smoking status, every 1-kg increase in weight from weeks 0 to 48 was significantly associated increases in several fasting metabolic markers, as follows:
- Total cholesterol (0.63 mg/dL; 95% CI, 0.38-0.89; P =.05);
- Low-density lipoprotein cholesterol (0.39 mg/dL; 95% CI, 0.19-0.59; P <.001); and
- Triglycerides (1.42 mg/dL; 95% CI, 0.61-2.22; P <.001).
Of note, high-density lipoprotein cholesterol was reduced by 0.04 mg/dL (95% CI, -0.13 to 0.05; P =.039) for every 1-kg increase in weight from weeks 0 to 48. In addition, the researchers noted no evidence of effect modification by sex, race, or ethnicity for the association between weight gain and change in fasting metabolic markers.
Further analysis indicated that the risk for incident diabetes was significantly higher among patients whose percent change in body weight by week 48 was greater than 10% vs between -5% and 5% (HR, 2.05; 95% CI, 1.30-3.08). Stratified by sex, the risk for incident diabetes among men was 2.5-times higher at week 48 among those who experienced weight gain of more than 10% vs between -5% and 5% (HR, 2.48; 95% CI, 1.55-3.98). However, this finding was not observed when the analysis was restricted to women.
Metabolic syndrome occurred in 360 patients after week 48. Analysis of these patients showed reduced risk for metabolic syndrome among those whose body weight was reduced by more than 5% from baseline (HR, 0.60; 95% CI, 0.37-0.98). In addition, the risk for metabolic syndrome was 2-times higher in patients who experienced weight gain of more 10% vs between -5% and 5% (HR, 2.02; 95% CI, 1.55-2.62). However, after stratification by race, the association between higher weight gain (>5%-10% vs -5% to 5%) and the occurrence of metabolic syndrome was only observed in White patients.
An analysis of 28 incident cardiovascular events that occurred after week 48 indicated none were associated with changes in body weight.
Study limitations include the observational design, potential unmeasured confounding, the inability to account for switches in ART regimens, and the small number of incident cardiovascular events.
According to the researchers, “Additional research is needed to determine whether weight control interventions at the time of ART initiation may help to minimize the risk of subsequent cardiometabolic disease.”
Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
By Lisa Kuhns, PhD
References:
Bares SH, Wu X, Tassiopoulos K, et al; for the A5322 Study Team. Weight gain after antiretroviral therapy initiation and subsequent risk of metabolic and cardiovascular disease. Clin Infect Dis. Published online September 12, 2023. doi:10.1093/cid/ciad545
SEE ALSO:
- Healio: Weight gain after ART initiation associated with long-term cardiovascular, metabolic risks
- Aidsmap: Greater weight gain in first year of HIV treatment raises risks of diabetes, metabolic syndrome and precursors of heart disease
Source : Infectious Disease Advisor
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