Relationship between Body Mass Index and Mortality in HIV-Infected HAART Users in the Women's Interagency HIV Study

BACKGROUND:

Early HIV studies suggested protective associations of overweight against mortality, yet data are lacking for the era of potent highly active antiretroviral therapy (HAART). We evaluated associations of pre-HAART initiation body mass index (BMI) with mortality among HAART-using women.

METHODS:

Prospective study of time to death after HAART initiation among continuous HAART users in the Women's Interagency HIV Study. Unadjusted Kaplan-Meier and adjusted proportional hazards survival models assessed time to AIDS and non-AIDS death by last measured pre-HAART BMI.

RESULTS:

Of 1428 continuous HAART users 39 (2.7%) were underweight, 521 (36.5%) normal weight, 441 (30.9%) overweight, and 427 (29.9%) obese at time of HAART initiation. A total of 322 deaths occurred during median follow-up of 10.4 years (IQR 5.9-14.6). Censoring at non-AIDS death, the highest rate of AIDS death was observed among underweight women (p = 0.0003 for all 4 categories). In multivariate models, women underweight prior to HAART died from AIDS more than twice as rapidly vs. normal weight women (aHR 2.04, 95% CI 1.03, 4.04); but being overweight or obese (vs. normal weight) was not independently associated with AIDS death. Cumulative incidence of non-AIDS death was similar across all pre-HAART BMI categories.

CONCLUSIONS:

Among continuous HAART-using women, being overweight prior to initiation was not associated with lower risk of AIDS or non-AIDS death. Being underweight prior to HAART was associated with over double the rate of AIDS death in adjusted analyses. Although overweight and obesity may be associated with many adverse health conditions, neither was predictive of mortality among the HAART-using women.

Full article at:   http://goo.gl/kt6cmo

By:   Sharma A1, Hoover DR2, Shi Q3, Gustafson D4, Plankey MW5, Hershow RC6, Tien PC7, Golub ET8, Anastos K1.

• 1Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America.
• 2Department of Statistics and Biostatistics, Rutgers University, Piscataway, New Jersey, United States of America.
• 3Department of Epidemiology and Community Health, New York Medical College, Valhalla, New York, United States of America.
• 4Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America.
• 5Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America.
• 6Department of Epidemiology, University of Illinois at Chicago, Chicago, Illinois, United States of America.
• 7Department of Medicine, Division of Infectious Diseases, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
• 8Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. 

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