Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul 1;1(2):ofu040.
doi: 10.1093/ofid/ofu040. eCollection 2014 Sep.

Obesity Trends and Body Mass Index Changes After Starting Antiretroviral Treatment: The Swiss HIV Cohort Study

Barbara Hasse  1 , Martin Iff  2 , Bruno Ledergerber  1 , Alexandra Calmy  3 , Patrick Schmid  4 , Christoph Hauser  5 , Matthias Cavassini  6 , Enos Bernasconi  7 , Catia Marzolini  8 , Philip E Tarr  2 ; Swiss HIV Cohort Study; V Aubert, J Barth, M Battegay, E Bernasconi, J Böni, H C Bucher, C Burton-Jeangros, A Calmy, M Cavassini, M Egger, L Elzi, J Fehr, J Fellay, H Furrer, C A Fux, M Gorgievski, H Günthard, D Haerry, B Hasse, H H Hirsch, I Hösli, C Kahlert, L Kaiser, O Keiser, T Klimkait, R Kouyos, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, K Metzner, N Müller, D Nadal, G Pantaleo, A Rauch, S Regenass, M Rickenbach, C Rudin, F Schöni-Affolter, P Schmid, D Schultze, J Schüpbach, R Speck, C Staehelin, P Tarr, A Telenti, A Trkola, P Vernazza, R Weber, S Yerly
Affiliations

Obesity Trends and Body Mass Index Changes After Starting Antiretroviral Treatment: The Swiss HIV Cohort Study

Barbara Hasse et al. Open Forum Infect Dis. .

Abstract

Background: The factors that contribute to increasing obesity rates in human immunodeficiency virus (HIV)-positive persons and to body mass index (BMI) increase that typically occurs after starting antiretroviral therapy (ART) are incompletely characterized.

Methods: We describe BMI trends in the entire Swiss HIV Cohort Study (SHCS) population and investigate the effects of demographics, HIV-related factors, and ART on BMI change in participants with data available before and 4 years after first starting ART.

Results: In the SHCS, overweight/obesity prevalence increased from 13% in 1990 (n = 1641) to 38% in 2012 (n = 8150). In the participants starting ART (n = 1601), mean BMI increase was 0.92 kg/m(2) per year (95% confidence interval, .83-1.0) during year 0-1 and 0.31 kg/m(2) per year (0.29-0.34) during years 1-4. In multivariable analyses, annualized BMI change during year 0-1 was associated with older age (0.15 [0.06-0.24] kg/m(2)) and CD4 nadir <199 cells/µL compared to nadir >350 (P < .001). Annualized BMI change during years 1-4 was associated with CD4 nadir <100 cells/µL compared to nadir >350 (P = .001) and black compared to white ethnicity (0.28 [0.16-0.37] kg/m(2)). Individual ART combinations differed little in their contribution to BMI change.

Conclusions: Increasing obesity rates in the SHCS over time occurred at the same time as aging of the SHCS population, demographic changes, earlier ART start, and increasingly widespread ART coverage. Body mass index increase after ART start was typically biphasic, the BMI increase in year 0-1 being as large as the increase in years 1-4 combined. The effect of ART regimen on BMI change was limited.

Keywords: HIV infection; antiretroviral therapy; body mass index; immunosuppression; longitudinal study; obesity.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Longitudinal trends of population body mass index (BMI) categories and median BMI trajectory, entire Swiss HIV Cohort Study population, 1990–2012. Note: Confidence intervals are omitted for visual clarity. Abbreviations: AIDS, acquired immune deficiency syndrome; IDU, injection drug user; ART, antiretroviral therapy.
Fig. 2.
Fig. 2.
Adjusted predicted annualized body mass index (BMI) changes during years 0–1 and years 1–4 of ART start. Separate predictions of BMI changes/year are presented for human immunodeficiency virus transmission category, gender, ethnicity, and age groups. Results are based on multivariable regression models adjusted for transmission category, ethnicity, age group, CD4 categories, and smoking status. For predictions, we fixed the remaining variables CD4 at 200–350, never smoking, and baseline BMI of 22 kg/m2. Abbreviations: hetero, heterosexual; MSM, men who have sex with men.
See this image and copyright information in PMC

References

    1. Freiberg MS, Chang CC, Kuller LH, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173:614–22. - PMC - PubMed
    1. Reis JP, Loria CM, Lewis CE, et al. Association between duration of overall and abdominal obesity beginning in young adulthood and coronary artery calcification in middle age. JAMA. 2013;310:280–8. - PMC - PubMed
    1. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects) Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet. 2014;383:970–83. - PMC - PubMed
    1. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71–82. - PMC - PubMed
    1. Carr A, Samaras K, Burton S, et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS. 1998;12:F51–8. - PubMed