Rising Obesity Prevalence and Weight Gain among Adults Starting Antiretroviral Therapy in the United States and Canada

The proportion of overweight and obese adults in the United States and Canada has increased over the past decade, but temporal trends in body mass index (BMI) and weight gain on antiretroviral therapy (ART) among HIV-infected adults have not been well characterized. 

We conducted a cohort study comparing HIV-infected adults in the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to United States National Health and Nutrition Examination Survey (NHANES) controls matched by sex, race, and age over the period 1998 to 2010. Multivariable linear regression assessed the relationship between BMI and year of ART initiation, adjusting for sex, race, age, and baseline CD4(+) count. Temporal trends in weight on ART were assessed using a generalized least-squares model further adjusted for HIV-1 RNA and first ART regimen class. 

A total of 14,084 patients from 17 cohorts contributed data; 83% were male, 57% were nonwhite, and the median age was 40 years. Median BMI at ART initiation increased from 23.8 to 24.8 kg/m(2) between 1998 and 2010 in NA-ACCORD, but the percentage of those obese (BMI ≥30 kg/m(2)) at ART initiation increased from 9% to 18%. After 3 years of ART, 22% of individuals with a normal BMI (18.5-24.9 kg/m(2)) at baseline had become overweight (BMI 25.0-29.9 kg/m(2)), and 18% of those overweight at baseline had become obese. HIV-infected white women had a higher BMI after 3 years of ART as compared to age-matched white women in NHANES (p = 0.02), while no difference in BMI after 3 years of ART was observed for HIV-infected men or non-white women compared to controls. 

The high prevalence of obesity we observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future.

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By:   Koethe JR¹, Jenkins CA¹, Lau B², Shepherd BE¹, Justice AC^3,4, Tate JP^3,4, Buchacz K⁵, Napravnik S⁶, Mayor AM⁷, Horberg MA⁸, Blashill AJ⁹, Willig A¹⁰,Wester CW¹, Silverberg MJ¹¹, Gill J¹², Thorne JE², Klein M¹³, Eron JJ⁶, Kitahata MM¹⁴, Sterling TR¹, Moore RD²; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

¹ Vanderbilt University School of Medicine , Nashville, Tennessee.

² Johns Hopkins University , Baltimore, Maryland.

³ Yale School of Medicine , New Haven, Connecticut.

⁴ VA Connecticut Healthcare System , West Haven, Connecticut.

⁵ Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .

⁶6 University of North Carolina , Chapel Hill, North Carolina.

⁷7 Universidad Central del Caribe , Bayamon, Puerto Rico .

⁸8 Mid-Atlantic Permanente Research Institute , Rockville, Maryland.

⁹9 Harvard Medical School , Boston, Massachusetts.

¹⁰10 University of Alabama at Birmingham , Birmingham, Alabama.

¹¹11 Kaiser Permanente Northern California , Oakland, California.

¹²12 Alberta HIV Clinic , Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada .

¹³13 McGill University Health Center , Montreal, Quebec, Canada .

¹⁴14 University of Washington , Seattle, Washington.

AIDS Res Hum Retroviruses. 2016 Jan;32(1):50-8. doi: 10.1089/aid.2015.0147. Epub 2015 Sep 9.

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