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

Han WM 1 , Jiamsakul A 1 , Jantarapakde J 2 , Yunihastuti E 3 , Choi JY 4 , Ditangco R 5 Show all authors , Chaiwarith R 6 , Sun LP 7 , Khusuwan S 8 , Merati TP 9 , Do CD 10 , Azwa I 11 , Lee MP 12 , Van Nguyen K 13 , Chan YJ 14 , Kiertiburanakul S 15 , Ng OT 16 , Tanuma J 17 , Pujari S 18 , Zhang F 19 , Gani YM 20 , Sangle S 21 , Ross J 22 , Kumarasamy N 23 , the TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific

Affiliations 

  • 1 The Kirby Institute, UNSW, Sydney, NSW, Australia
  • 2 HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 3 Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 4 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 5 Research Institute for Tropical Medicine, Muntinlupa City, Philippines
  • 6 Research Institute for Health Sciences, Chiang Mai, Thailand
  • 7 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
  • 8 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 9 Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
  • 10 Bach Mai Hospital, Hanoi, Vietnam
  • 11 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 12 Queen Elizabeth Hospital, Hong Kong SAR, India
  • 13 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 14 Taipei Veterans General Hospital, Taipei, Taiwan
  • 15 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 16 Tan Tock Seng Hospital, Singapore, Singapore
  • 17 National Center for Global Health and Medicine, Tokyo, Japan
  • 18 Institute of Infectious Diseases, Pune, India
  • 19 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 20 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 21 BJ Government Medical College and Sassoon General Hospital, Pune, India
  • 22 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
  • 23 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
HIV Med, 2021 Apr;22(4):294-306.
PMID: 33200864 DOI: 10.1111/hiv.13017

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 ( 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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