Cardiovascular disease has become a major cause of morbidity and mortality in persons with HIV infection.13–17,48–51 Because overweight- and obesity-related complications, such as diabetes mellitus, are associated with an increased risk of cardiovascular disease, prevention of excessive weight gain in HIV-infected persons may represent a currently overlooked opportunity for primary prevention. Although recent research suggests that being overweight may reduce the risk of death in general populations, obesity still carries major health risks.52,53 Nationally, the prevalence of overweight and obesity increased rapidly from the 1960s to 2004, but remained relatively stable over the past decade.54 This is not the case for our HIV-infected cohort, in whom one quarter were gaining weight at a rate over 5 times faster than the general population.43,44 Our analysis of longitudinal changes in BMI predicts that nearly 30% of HIV+ patients who are overweight at baseline will become obese within 4 years.
There are several limitations to this analysis. Our study population received care from only 1 HIV clinic, albeit the largest such clinic in south-central Texas, and although most patients receive care within our county health care system, any outside clinical encounters would not be documented. We did not have a direct measure of SES or time on ART, and some patients only had 2 BMI measurements, though only 3.7% of cohort had <12 months observation time. We also lacked information about the reasons for weight gain, which for some patients and their providers may be a goal of treatment. Before the advent of potent ART, obesity was found to be protective against both mortality and disease progression.28,56–60 Recent studies suggest that overweight may be associated with improved immune response to ART; however, obesity was associated with a less robust immune response.33,35,61 To address this limitation, we excluded underweight patients at baseline and adjusted for the level of immunodeficiency. We also conservatively examined a threshold for significant weight gain that is at least 5 times higher than that observed in the general population.43,44
The authors gratefully recognize University Health System (UHS) for their support of this project. Specific thanks are due to Lisa Wammack, Tracy Jeffers, and Michelle Silva of UHS for their assistance in developing the data repository for the South Texas HIV Cohort, and all of the patients and providers at the UHS Family Focused AIDS Clinical Treatment & Services clinic.
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