Impact of genetic and nongenetic factors on body mass index and waist-hip ratio change in HIV-infected individuals initiating antiretroviral therapy. Open Forum of Infectious Diseases
Barcelo et al. aimed to investigate the impact of genetic and nongenetic factors on body mass index (BMI) and waist-hip ratio (WHR) change in HIV-infected individuals initiating antiretroviral therapy. The authors used mixed-effects models characterizing BMI and WHR change over time in 1’090 SHCS participants initiating antiretroviral therapy (ART) between 2005 and 2015 to quantify the influence of demographics, clinical factors, and genetic background.
Individuals with CD4 nadir <100 cells/μL gained 6.4 times more BMI than individuals with ≥200, and 2.8 times more WHR than individuals with ≥100 (P < .001) during the first 1.5 and 2.5 years after ART initiation, respectively. The risk of being over-weight or obese after 1.5 years increased with CD4 nadir <100 cells/μL compared to 100–199 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.63–2.74) and ≥200 (OR, 1.69; 95% CI, 1.26–2.32), persisting after 10 years of ART. The risk of abdominal obesity after 2.5 years increased with CD4 nadir <100 compared to ≥100 (OR, 1.35; 95% CI, 1.17–1.54 [in men]; OR, 1.36; 95% CI, 1.18–1.57 [in women]), persisting after 10 years of ART. No significant differences were found across antiretroviral drug classes or genetic scores.
In conclusion, the present models identified the critical period of 1.5 and 2.5 years after ART initiation where HIV-infected individuals are more prone to increase their BMI and WHR, respectively. These findings support the need to inform individuals starting ART about the likely early-on body composition changes despite the benefits of starting ART that vastly outweigh this risk. Regular monitoring and implementation of early weight management interventions to address body weight and fat gain are to be encouraged, especially in individuals initiating ART with a low nadir CD4 cell count. The present BMI and WHR models also can be applied to test the efficacy of such interventions, either pharmacological or lifestyle modifications, at different time points after ART initiation and further developed into joint models to predict incidence of CV events in the HIV-infected population.