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. 2021 Apr;22(4):294-306.
doi: 10.1111/hiv.13017. Epub 2020 Nov 17.

Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV

W M Han  1   2 , A Jiamsakul  1 , J Jantarapakde  2 , E Yunihastuti  3 , J Y Choi  4 , R Ditangco  5 , R Chaiwarith  6 , L P Sun  7 , S Khusuwan  8 , T P Merati  9 , C D Do  10 , I Azwa  11 , M-P Lee  12 , K Van Nguyen  13 , Y-J Chan  14 , S Kiertiburanakul  15 , O T Ng  16 , J Tanuma  17 , S Pujari  18 , F Zhang  19 , Y M Gani  20 , S Sangle  21 , J Ross  22 , N Kumarasamy  23 ; the TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific
Affiliations

Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV

W M Han et al. HIV Med. 2021 Apr.

Abstract

Objectives: We conducted a longitudinal cohort analysis to evaluate the association of pre-treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV).

Methods: Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated-measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds.

Results: Of 4993 PLHIV (66% male), 62% had pre-treatment BMI in the normal range (18.5-25.0 kg/m2 ), while 26%, 10% and 2% were underweight (< 18.5 kg/m2 ), overweight (25-30 kg/m2) and obese (> 30 kg/m2 ), respectively. Both higher baseline and time-updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23-27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9-28.3] and 28.8 cells/µL (95% CI: 6.6-50.9), respectively, compared with normal BMI (18.5-23 kg/m2 ). PLHIV with BMIs of 25-30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10-1.47) and 1.61 times (95% CI: 1.13-2.24) more likely to develop CVD risk factors. No relationship between pre-treatment BMI and VF was observed.

Conclusions: High pre-treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.

Keywords: HIV; body mass index; cardiovascular risks; immune recovery; virological response.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest related to this work.

Figures

Figure 1.
Figure 1.. Mean increase in CD4 cell count from ART initiation by BMI categories
A total of 4238 people living with HIV (PLHIV) contributed to pre-ART CD4 count at baseline. Figure 1 shows overall mean increase in CD4 count from baseline, stratified by BMI groups (<18.5, 18.5–25, 25–30 and >30 kg/m2)
Figure 2.
Figure 2.. Kaplan-Meier plot for time to CVD risk markers by BMI categories
Figure 2A illustrates the differences in probability of development of CVD risk markers over time for each BMI group for all participants, and Figure 2B and Figure 2C illustrate the development of CVD risk markers for males and females, respectively.
Figure 3.
Figure 3.. Association of BMI with cardiovascular risk markers
Figure 3A and 3B shows the association of cardiovascular risks and baseline BMI using among men and women. Figure 3C and 3D shows the association of cardiovascular risks and time-updated BMI among men and women. The adjusted hazard ratios are from the Cox regression models which were adjusted for significant covariates from the univariable models and were stratified by sites. Error bars denoted 95% confidence intervals. Baseline BMI of 18.5–23 kg/m2 were used as a reference group.
See this image and copyright information in PMC

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