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Growth curve modelling to determine distinct BMI trajectory groups in HIV-positive adults on antiretroviral therapy in South Africa

Brennan, Alana T.a,b,c; Berry, Kaitlyn M.a; Rosen, Sydneya,b; Stokes, Andrewa; Crowther, Nigel J.d; George, Jayad; Raal, Fredericke; Cassim, Naseemf; Sanne, Iana,b,g,h; Long, Lawrencea,b; Fox, Matthew P.a,b,c

doi: 10.1097/QAD.0000000000002302
EPIDEMIOLOGY AND SOCIAL
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Objective: Obesity is a major long-term concern in HIV-positive patients due to the pathogenic link between obesity and noncommunicable chronic diseases (NCDs). We aim to characterize changes in BMI over time on antiretroviral therapy (ART) and investigate the association between weight gain and survival in South Africa.

Design and methods: A prospective cohort study among HIV-positive adults on first-line ART between April 2004 and 2015 in Johannesburg, South Africa. We used latent-class growth modelling (adjusted for age, sex and CD4+ cell count) to identify groups of individuals with similar patterns of change in BMI over time.

Results: Eleven thousand, two hundred and sixty-three patients were included. The best fit model involved two linear and two quadratic trajectories. Thirty-five percent of patients were categorized into group one (mean BMI at ART initiation, 20.4 kg/m2; mean BMI after 8 years of follow-up, 20.9 kg/m2), 38% into group two (24.5–26.2 kg/m2), 21% into group three (29.5–32.6 kg/m2) and 6% into group four (36.5–40.0 kg/m2). Over the 8 years of follow-up, 6% of our cohort went down in BMI standard category, while 45% went up. The largest increase occurred in the first 12 months on ART. In years 2 through 8, we saw a more gradual increase in BMI.

Conclusion: The largest gain in BMI in HIV patients occurred in the first year on ART. During follow-up, over 50% of our population changed BMI categories putting them at an increased risk for NCDs. Consistent counselling on nutritional and lifestyle changes could help improve ART patients’ long-term health outcomes.

aDepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA

bHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

cDepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA

dDepartment of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Parktown

eDepartment of Medicine, Faculty of Health Sciences

fDepartment of Molecular Medicine and Haematology, National Health Laboratory Service

gClinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand

hRight to Care, Johannesburg, South Africa.

Correspondence to Dr Alana T. Brennan, Department of Global Health, Boston University School of Public Health Crosstown Center, 3rd Floor, 801 Massachusetts Ave, Boston, MA 02118, USA. Tel: +1 617 217 1149; e-mail: abrennan@bu.edu

Received 9 January, 2019

Revised 20 May, 2019

Accepted 24 May, 2019

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Copyright © 2019 Wolters Kluwer Health, Inc.