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Some weight gain after starting ART may reduce mortality
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In HIV patients who are initially normal weight or underweight, weight gain within the first year after ART initiation was associated with decreased mortality, according to recent findings.
“On one hand, early weight gain after ART likely reflects reduced metabolic demand from viral replication, which suggests improved clinical outcome,” researchers wrote in Clinical Infectious Diseases. “On the other hand, overweight and obesity among those without HIV confer increased risk of morbidity (diabetes, cardiovascular disease and stroke) and mortality. Now that people are aging with HIV infection, we need to consider what constitutes an optimal weight gain after ART.”
Amy C. Justice, MD, PhD, professor of medicine at Yale School of Medicine and section chief of general medicine at Veterans Affairs Connecticut Healthcare System, and colleagues evaluated weight change in the first year after ART initiation and its association with mortality in HIV-infected patients enrolled in the Veterans Aging Cohort Study. They collected data on 4,184 men and 127 women (mean age, 47.9 years) who initiated ART between 2000 and 2008. All eligible patients had weight recorded at baseline and 1 year later and were followed for another 5 years. The researchers classified baseline BMI as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30) and obese (≥ 30).
Amy C. Justice
Among patients who were underweight at baseline, all weight gain seemed to be beneficial — 10 pounds or greater of weight gained was associated with a significantly decreased mortality risk (HR = 0.47; 95% CI, 0.25-0.88) vs. those whose weight did not change. In normal weight patients, survival benefits were associated with at least 10 pounds but less than 20 pounds of weight gain (HR = 0.56; 95% CI, 0.41-0.78). There was no clear benefit of weight gain, however, for overweight and obese patients, according to the researchers.
An overall association was seen between weight loss after ART initiation and increased mortality risk; this association was statistically significant for patients who were initially normal weight, overweight or obese.
Further analysis showed that the likelihood of weight gain was strongly associated with baseline weight, CD4 cell count and hemoglobin levels, and the risk for weight gain was higher among those with more severe disease, independent of baseline weight.
“Providers should monitor weight gain among normal and underweight patients initiating ART and examine potential reasons for failure to gain weight, including viral breakthrough, ongoing inflammation, food insecurity, drug use and intervening comorbidities,” Justice and colleagues wrote. “Overweight and obese patients can be counseled to engage in healthy diet and exercise behavior.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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