Weight gain post-ART in HIV+ Latinos/as differs in the USA, Haiti, and Latin America

Abstract

Background: An obesity epidemic has been documented among adult Latinos/as in Latin America and the United States (US); however, little is known about obesity among Latinos/as with HIV (PWH). Moreover, Latinos/as PWH in the US may have different weight trajectories than those in Latin America due to the cultural and environmental contexts. We assessed weight and body mass index (BMI) trajectories among PWH initiating antiretroviral therapy (ART) across 5 countries in Latin America and the Caribbean and the US.

Methods: ART-naÿve PWH ≥18 years old, enrolled in Brazil, Honduras, Mexico, Peru, and Haiti (sites within CCA-SAnet) and the US (NA-ACCORD) starting ART between 2000 and 2017, with at least one weight measured after ART initiation were included. Participants were classified according to site/ethnicity as: Latinos/as in US, non-Latinos/as in US, Haitians, and Latinos/as in Latin America. Generalized least squares models were used to assess trends in weight and BMI. Models estimating probabilities of becoming overweight/obese (BMI ≥25 kg/m²) and of becoming obese (BMI ≥30 kg/m²) post ART initiation for males and females were fit using generalized estimating equations with a logit link and an independence working correlation structure.

Findings: Among 59,207 PWH, 9% were Latinos/as from Latin America, 9% Latinos/as from the US, 68% non-Latinos/as from the US and 14% were Haitian. At ART initiation, 29% were overweight and 14% were obese. Post-ART weight and BMI increases were steeper for Latinos/as in Latin America compared with other sites/ethnicities; however, BMI at 3-years post ART remained lower compared to Latinos/as and non-Latinos/as in the US. Among females, at 3-years post ART initiation the greatest adjusted probability of obesity was found among non-Latinas in the US (15·2%) and lowest among Latinas in Latin America (8.6%). Among males, while starting with a lower BMI, Latinos in Latin America had the greatest adjusted probability of becoming overweight or obese 3-years post-ART initiation.

Interpretation: In the Americas, PWH gain substantial weight after ART initiation. Despite environmental and cultural differences, PWH in Latin America, Haiti and Latinos and non-Latinos in the US share similar BMI trajectories on ART and high probabilities of becoming overweight and obese over time. Multicohort studies are needed to better understand the burden of other metabolic syndrome components in PWH across different countries.

Keywords: Antiretroviral; Ethnicity; HIV; Latin America; Obesity; Weight gain.

Figure 1

Estimated changes in weight and BMI after ART initiation summarized by birth sex according to site/ethnicity Average weight (upper left and right panels) and BMI (lower left and right panels) and 95% confidence intervals were estimated from adjusted models. Covariates included in the models were time since ART initiation, the initial antiretroviral class regimen, birth sex, year of ART initiation, and baseline age, CD4 count and HIV viral load. Time was interacted with baseline weight or BMI, sex, and ethnicity. An interaction between sex and ethnicity was also included.

Figure 2

Probabilities of becoming overweight or obese (subset of PWH with BMI <25 kg/m² at ART initiation) and probabilities of becoming obese (subset of PWH with BMI <30 kg/m² at ART initiation) among males and females according to site/ethnicity Probabilities and 95% confidence intervals. Covariates included in the models were time since ART initiation, the initial antiretroviral class regimen, birth sex, year of ART initiation, and baseline age, CD4 count and HIV viral load. Time was interacted with baseline weight or BMI, sex, and ethnicity. An interaction between sex and ethnicity was also included.