Many studies through the years have shown increases in body weight among HIV-positive persons taking antiretroviral therapy (ART). Weight gain is thought to be a side-effect of some HIV medications but may also be attributed to life-style issues and genetic factors. This study from the D:A:D cohort looked at changes in body mass index (BMI) from the patients’ baseline BMI and the subsequent risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Entry into this cohort was from 1999 to 2009 with data collection through 2016. The study included 43,011 participants of whom 75% were male with a mean age of 40 years. Median BMI was normal at 23 kg/m2 but 37% were smokers. Patients were stratified according to their baseline BMI as <20, 20-24.9, 25-29.9 and >30 kg/m2 and subsequently stratified through follow-up visits based on changes in BMI at follow-up clinic visits. Composite endpoints were first CVD event (MI/stroke/cardiovascular procedure) and first DM event (fasting glucose >126, HbA1c >6.5%, GTT >200, or use of antidiabetic drug). During a follow up of approximately 360,000 person years there were 2,104 CVD events (5.8/1000 pt. yrs) and 1,583 DM events (4.5/1000 pt. years). Both rates were significantly higher in males than females. There was no increased CVD risk with increase in BMI in any of the four strata but some evidence of increased risk with a decrease in BMI, especially if <20 kg/m2. However, an increase in BMI across all levels from baseline was associated with increased risk of DM. The authors note in their conclusion “the extent to which these results apply to HIV-positive people with increased weight while receiving contemporary ARVs are uncertain.”
Data from the large observational D:A:D cohort has provided a great deal of information through the years – but is limited by being observational and from my perspective, often leaves additional questions unanswered. Despite weight gain in this sample of patients there was no overall increased risk of CVD, so certainly a good outcome. In addition, the overall incidence rates of both CVD and DM were low. However, this study did not assess the impact of specific ARVs – including Integrase inhibitors. There was also no information regarding diet and exercise.