People With HIV Starting Antiretroviral Therapy Gain Excess Weight in First 2 Years

Using a large health care dataset, researchers found that people with HIV (PWH) had greater increases in BMI (kg/m²) during the first 2 years after starting antiretroviral therapy (ART) than people without HIV (PWoH) who did not receive ART. The authors noted that weight gain during ART could diminish some of its benefits, such as virologic suppression and reduced inflammation.

Researchers developed a retrospective cohort study examining data obtained from electronic health records among PWH (n = 8256) initiating ART and demographically matched PWoH (n = 129,966). The study participants included adults (≥ 21 years old) who were matched by sex, age, and race or ethnicity. The mean baseline age for PWH was 40.9 years and 42.2 years for PWoH. A total of 88% of the study participants were men.

The researchers categorized baseline BMI as underweight/normal, overweight, or obese. The ART classes examined were integrase strand transfer inhibitor (INSTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), and protease inhibitor (PI). The first ART regimens among PWH following their diagnosis were NNRTIs (48.9%), INSTIs (26.6%), and PIs (24.5%). Models were adjusted for sociodemographic, comorbidities, and substance use.

The results showed that in adjusted models, the average annual change in BMI in the first 2 years after ART initiation was 0.53 kg/m² for PWH and 0.12 kg/m² for PWoH (P < .001).

Researchers examined all ART classes and found that for each, BMI increased among PWH receiving ART compared with PWoH:

• INSTI: 0.69 kg/m² vs. 0.12 kg/m²
• PI: 0.69 kg/m² vs. 0.12 kg/m²
• NNRTI: 0.40 kg/m² vs 0.12 kg/m²

After more than 2 years after ART initiation, BMI stabilized among PWH and increased slightly among PWoH.

This study had limitations. For example, researchers noted that BMI is an imprecise measure that frequently changes. Additionally, they could not account for some lifestyle and behavioral factors that may impact BMI, such as caloric intake and level of physical activity.

Still, the authors noted the importance for PWH to monitor their weight after starting ART.

“PWH initiating ART gained excess weight in the first 2 years, emphasizing the importance of monitoring weight and cardiometabolic health among ART-treated PWH,” the authors concluded.

Reference:
Lam JO, Leyden WA, Alexeeff S, et al. Changes in body mass index over time in people with and without HIV infection. Open Forum Infect Dis. Published online February 6, 2024. doi:10.1093/ofid/ofad611