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As America gets fatter, so do its HIV-infected patients. Still, it has never been clear whether weight trends among the HIV-infected are simply a reflection of prevailing population norms or have a more complicated etiology. Researchers studied weight changes in 92 consecutive patients (84% men; mean age, 38; 50% with CD4-cell counts <200 cells/mm3) who were seen at a single HIV clinic in Durham, North Carolina, between 1998 and 2008 and began and remained on an initial antiretroviral therapy (ART) regimen for at least 12 months. Those taking any other drugs likely to affect weight were excluded, as were those with any coexisting malignancy or metabolic condition.
At study entry, participants' mean weight was 80 kg and mean body-mass index was 26.4 kg/m2 — both higher than optimal but still significantly lower than in age-matched HIV-uninfected controls followed at the same institution. Only 52% of the HIV-infected group was overweight or obese, in contrast to 91% of the controls.
During the first year on ART, weight in the HIV-infected group increased significantly; weight in the control group remained largely unchanged. HIV-infected participants who had been underweight or normal-weight at study entry gained a mean of 5.5 kg; those who were initially overweight or obese gained a mean of 3.5 kg. Among the 44 participants who were not overweight or obese before starting ART, 9 became overweight and 6 became obese.
Weight gain was seen in virtually all subsets of the HIV-infected group; it was greatest among African-Americans, women, those with initial CD4 counts <200 cells/mm3, and those treated with protease inhibitor–based regimens. The prevalence of dyslipidemia, hypertension, or both, among participants classified as overweight or obese increased from 49% at baseline to 74% after 12 months on ART; no new cases of diabetes occurred.
Lakey W et al. From wasting to obesity: Initial antiretroviral therapy and weight gain in HIV-infected persons. AIDS Res Hum Retroviruses 2013 Mar; 29:435. (http://dx.doi.org/10.1089/aid.2012.0234)
Comment
These data certainly suggest that ART allows HIV-infected people to achieve population weight norms, however undesirable those may be. The numbers were too small to parse the effects of individual drugs or dietary habits. However, experience leads me to suspect that most of these participants were eating as much as they possibly could: Even if AIDS-related wasting has become a syndrome of the past, its specter still haunts infected people. They vastly prefer to be too big than too small, and it is a difficult but a necessary challenge to convince them otherwise.