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A Tale of 2 Epidemics: The Intersection Between Obesity and HIV Infection in Philadelphia

Amorosa, Valerianna MD*; Synnestvedt, Marie MSEd†; Gross, Robert MD, MSCE*†; Friedman, Harvey MD*; MacGregor, Rob Roy MD*; Gudonis, Debie LPN*; Frank, Ian MD*; Tebas, Pablo MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 August 2005 - Volume 39 - Issue 5 - pp 557-561
Brief Report: Clinical Science

Background: Obesity and HIV infection are ongoing epidemics in the United States. Obesity predisposes to diabetes and cardiovascular disease, which are complications also associated with HIV and/or its treatment.

Objective: To determine the prevalence and risk factors for overweight and obesity in HIV-infected individuals.

Design and Setting: Retrospective cross-sectional study in which 1689 patients enrolled in the University of Pennsylvania Center for AIDS Research Adult/Adolescent Database at 1 university hospital clinic, 2 affiliated practices, and 1 Veterans Administration clinic in Philadelphia had demographic, social, and medical data collected prospectively since 1999.

Participants: Body mass index (BMI) data were available for 1669 HIV-infected subjects: 78% were men, and 60% were African American. The median CD4 count was 381 cells/μL, 47% of subjects had a viral load <400 copies/mL, and 9% of subjects were treatment naive.

Main Outcome Measures: The prevalence and risk factors for overweight (BMI: 25-29.9 kg/m2) and obesity (BMI ≥30 kg/m2) in HIV-infected subjects.

Results: Obesity and overweight were more prevalent than wasting (14%, 31%, and 9%, respectively; P < 0.0005), but they were not more common than in the general population. Although women and men were equally overweight (30% vs. 31%), women were more obese than men (28% vs. 11%; P < 0.001). Among women, African American race (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1-2.9) and a CD4 count ≥200 cells/μL (OR = 2.8, 95% CI: 1.6-4.9) were associated with overweight and obesity. Among men, only a CD4 count ≥200 cells/μL (OR = 1.6, 95% CI: 1.04-2.4) was associated with increased BMI. In men and women, smoking was associated with decreased obesity and overweight (OR = 0.59, 95% CI: 0.47-0.74 and OR = 0.65, 95% CI: 0.43-0.98, respectively). Age, income, employment, education, past or current intravenous drugs, being on HIV treatment, and viral load were not associated with obesity in the multivariate model. There was a positive correlation between BMI and total cholesterol, triglycerides, and glucose.

Conclusion: Obesity is more common than wasting in this therapeutic era. Women, particularly those of African American race, are at high risk. Obesity might add to metabolic abnormalities associated with HIV or its treatment and contribute to morbidity, as patients with HIV live longer.

From the *Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA; and †Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.

Received for publication December 13, 2004; accepted May 12, 2005.

Supported by the Penn Center for AIDS Research (grant P30 AI45008) and AIDS Clinical Trial Group (grant AI 32783) from the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Presented in part at the 11th Retrovirus and Opportunistic Infection Conference, San Francisco, February 2004 (abstract Q-322).

Reprints: Pablo Tebas, Division of Infectious Diseases, University of Pennsylvania School of Medicine, 502 Johnson Pavilion, 36th Street and Hamilton Walk, Philadelphia, PA 19104-6073 (e-mail: pablo.tebas@uphs.upenn.edu).

© 2005 Lippincott Williams & Wilkins, Inc.