Body mass index and the risk of serious non-AIDS events and all-cause mortality in treated HIV-positive individuals: D:A:D Cohort analysis: Journal of Acquired Immune Deficiency Syndromes

A.C. Achhra, C. Sabin, L. Ryom, C. Hatleberg, M. Antonella D'Aminio, S. De Wit, A. Phillips, C. Pradier, R. Weber, P. Reiss, W. El-Sadr, F. Bonnet, A. Mocroft, J. Lundgren, M.G. Law, Ferran Torres

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16 Citations (Scopus)

Abstract

Background: The relationship between body mass index (BMI) [weight (kg)/height (m 2)] and serious non-AIDS events is not well understood. Methods: We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m 2. Results: Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of 30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001). Conclusions: Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI ( 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes. © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)579-588
Number of pages10
JournalJAIDS Journal of Acquired Immune Deficiency Syndromes
Volume78
Issue number5
DOIs
Publication statusPublished - Aug 2018

Keywords

  • AIDS
  • all-cause mortality
  • BMI
  • HIV
  • non-AIDS
  • obesity
  • abacavir
  • antiretrovirus agent
  • proteinase inhibitor
  • RNA directed DNA polymerase inhibitor
  • acquired immune deficiency syndrome
  • adult
  • adverse event
  • all cause mortality
  • antiretroviral therapy
  • Article
  • body mass
  • cardiovascular disease
  • cohort analysis
  • correlation analysis
  • diabetes mellitus
  • female
  • follow up
  • human
  • Human immunodeficiency virus infected patient
  • Human immunodeficiency virus infection
  • longitudinal study
  • major clinical study
  • male
  • malignant neoplasm
  • observational study
  • outcome assessment
  • Poisson distribution
  • priority journal
  • regression analysis
  • risk assessment
  • risk factor
  • sex
  • statistical analysis
  • statistical significance
  • cause of death
  • complication
  • middle aged
  • mortality
  • neoplasm
  • pathophysiology
  • Adult
  • Body Mass Index
  • Cardiovascular Diseases
  • Cause of Death
  • Cohort Studies
  • Diabetes Mellitus
  • Female
  • HIV Infections
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Poisson Distribution

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