Changes in body mass index among people living with HIV who are new on highly active antiretroviral therapy: a systematic review and meta-analysis

Abstract

In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m²; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I² = 85%; p < .01). Subgroup analyses showed pooled ES of 1.54 kg/m² (95% CI: 1.21, 1.87) and 1.63 kg/m² (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and >1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6-12 months on treatment, with minor gains in the second and subsequent years of treatment.

Keywords: Highly active antiretroviral therapy (HAART); body mass index (BMI); meta-analysis; obesity; people living with HIV (PLHIV); systematic review.