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Weight changes, metabolic syndrome and all-cause mortality among Asian adults living with HIV

Han WM 1 , Law MG 1 , Choi JY 2 , Ditangco R 3 , Kumarasamy N 4 , Chaiwarith R 5 Show all authors , Ly PS 6 , Khusuwan S 7 , Merati TP 8 , Do CD 9 , Yunihastuti E 10 , Azwa I 11 , Lee MP 12 , Pham TN 13 , Chan YJ 14 , Kiertiburanakul S 15 , Ng OT 16 , Tanuma J 17 , Pujari S 18 , Zhang F 19 , Gani Y 20 , Mave V 21 , Ross J 22 , Avihingsanon A 23 , TREAT Asia HIV Observational Database of IeDEA Asia-Pacific

Affiliations 

  • 1 The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
  • 2 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 3 Research Institute for Tropical Medicine, Muntinlupa City, Philippines
  • 4 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS Infectious Diseases Medical Centre, VHS, Chennai, India
  • 5 Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand
  • 6 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
  • 7 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 8 Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
  • 9 Bach Mai Hospital, Hanoi, Vietnam
  • 10 Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 11 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 12 Queen Elizabeth Hospital, Hong Kong SAR, China
  • 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, National Centre for Infectious Diseases, 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- Johns Hopkins University Clinical Research Site, Pune, India
  • 22 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
  • 23 HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
HIV Med, 2022 Mar;23(3):274-286.
PMID: 34816562 DOI: 10.1111/hiv.13211

Abstract

OBJECTIVES: We investigated weight changes following antiretroviral therapy (ART) initiation, the development of metabolic syndrome (MetS) and its association with all-cause mortality among Asian adults living with HIV.

METHODS: Participants enrolled in a regional Asian HIV-infected cohort with weight and height measurements at ART initiation were eligible for inclusion in the analysis. Factors associated with weight changes and incident MetS (according to the International Diabetic Federation (IDF) definition) were analysed using linear mixed models and Cox regression, respectively. Competing-risk regression models were used to investigate the association of MetS with all-cause mortality.

RESULTS: Among 4931 people living with HIV (PLWH), 66% were male. At ART initiation, the median age was 34 [interquartile range (IQR) 29-41] years, and the median (IQR) weight and body mass index (BMI) were 55 (48-63) kg and 20.5 (18.4-22.9) kg/m2 , respectively. At 1, 2 and 3 years of ART, overall mean (± standard deviation) weight gain was 2.2 (±5.3), 3.0 (±6.2) and 3.7 (±6.5) kg, respectively. Participants with baseline CD4 count ≤ 200 cells/µL [weight difference (diff) = 2.2 kg; 95% confidence interval (CI) 1.9-2.5 kg] and baseline HIV RNA ≥ 100 000 HIV-1 RNA copies/mL (diff = 0.6 kg; 95% CI 0.2-1.0 kg), and those starting with integrase strand transfer inhibitor (INSTI)-based ART (diff = 2.1 kg; 95% CI 0.7-3.5 kg vs. nonnucleoside reverse transcriptase inhibitors) had greater weight gain. After exclusion of those with abnormal baseline levels of MetS components, 295/3503 had incident MetS [1.18 (95% CI 1.05-1.32)/100 person-years (PY)]. The mortality rate was 0.7 (95% CI 0.6-0.8)/100 PY. MetS was not significantly associated with all-cause mortality in the adjusted model (P = 0.236).

CONCLUSIONS: Weight gain after ART initiation was significantly higher among those initiating ART with lower CD4 count, higher HIV RNA and an INSTI-based regimen after controlling for baseline BMI. Greater efforts to identify and manage MetS among PLWH are needed.

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

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