AIDS 2014: Weight Gain on ART May Raise Risk of Heart Disease and Diabetes

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People with HIV who gain weight shortly after starting antiretroviral therapy (ART) may have an increased risk of cardiovascular disease and diabetes, according to findings from the D:A:D study presented this week at the 20th International AIDS Conference in Melbourne, Australia.

Several observational studies -- including the large international Data Collection o­n Adverse events of Anti-HIV Drugs (D:A:D) study -- have found that people with HIV have higher rates of cardiovascular disease and metabolic conditions such as diabetes. However, the relative contributions of HIV infection itself, resulting inflammatory and metabolic changes, antiretroviral toxicities, and other factors are not yet fully understood. Many people with HIV gain weight after starting ART, and this may have a detrimental effect on health.

Amit Achhrafrom the Kirby Institute in Sydney and colleagues looked at the relationship between short-term changes in body mass index (BMI) after treatment initiation and subsequent risk of cardiovascular disease and diabetes in the D:A:D cohort.

Out of nearly 50,000 participants in the full cohort, this analysis included 9321 people who were starting ART for the first time, had no prior history of cardiovascular disease before treatment initiation, and had BMI data available from before and 1 year after initiation. People who developed cardiovascular disease or diabetes within the first year after starting treatment were excluded.

About three-quarters of participants were men, the average age was approximately 40 years, and about 5% had a family history of heart disease. Before starting ART, 6% were underweight (BMI <18.5), 64% were normal weight (18.5-24.9), 23% were overweight (>25), and 6% were obese (>30). The median CD4 T-cell count was approximately 270 cells/mm3 in the latter 3 groups, but only 170 cells/mm3 in the underweight group, reflecting more advanced disease.

Overall, about one-third of participants were current smokers -- although heavier people were less likely to smoke -- and about 10% had hepatitis C virus coinfection. As expected, overweight and obese participants had higher blood pressure and were more likely to have pre-existing diabetes, rising from 1.6% among underweight people to 6.8% in the obese group.

The researchers looked at a composite cardiovascular disease endpoint that included myocardial infarctions or heart attacks, strokes, sudden cardiac death, and related surgical procedures such as coronary artery bypass or angioplasty. Diabetes assessment was based on medical records or use of anti-diabetic drugs.

Results

"Short-term gain in BMI post ART initiation could be associated with the increased risk of cardiovascular disease, largely in those with normal/mid-levels of pre-ART BMI," the researchers concluded. "Gain in BMI [was] also associated with risk of diabetes in all groups."

However, they added that there was "no appreciable change in risk of cardiovascular disease with gain in BMI in those with high pre-ART BMI."

As a limitation, they noted that BMI may not reflect abdominal or central obesity -- which is most strongly related to metabolic abnormalities and heart disease -- and the study did not have access to information about diet or exercise, which can affect risk independent of weight.

7/25/14

Reference

AC Achhra, A Mocroft, P Reiss, et al. Impact of short-term change in body mass index (BMI) after antiretroviral therapy (ART) initiation on subsequent risk of cardiovascular disease (CVD) and diabetes in HIV-positive individuals: the D:A:D study. 20th International AIDS Conference (AIDS 2014). Melbourne, July 20-25, 2014.Abstract WEAB0103.