title: HIV infection and obesity: where did all the wasting go?
abstract: BACKGROUND
  The success of antiretroviral therapy (ART) has led to dramatic changes in causes of morbidity and mortality in HIV-infected individuals. As chronic diseases rates have increased in HIV+ populations, modifiable risk factors such as obesity have increased in importance. Our objective was to evaluate factors associated with weight change among patients receiving ART.
  
  
  METHODS
  ART-naïve patients initiating therapy at the University of Alabama - Birmingham 1917 HIV/AIDS Clinic from 2000- 2008 were included. Body Mass Index (BMI) was categorized as: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9) and obese (≥30). Linear regression models were used to evaluate overall change in BMI and factors associated with increased BMI category 24 months following ART initiation.
  
  
  RESULTS
  Among 681 patients, the mean baseline BMI was 25.4 ± 6.1; 44% of patients were overweight/obese. At 24 months, 20% of patients moved from normal to overweight/obese or overweight to obese BMI categories. Greater increases in BMI were observed in patients with baseline CD4 count < 50 cells/µl (3.4 ± 4.1, P<0.01) and boosted protease inhibitor use (2.5±4.1 P=0.01), but did not account for all of the variation observed in weight change.
  
  
  CONCLUSIONS
  The findings that almost half of patients were overweight or obese at ART initiation, and 1 in 5 patients moved to a deleterious BMI category within 2 years of ART initiation are alarming. ART therapy provides only a modest contribution to weight gain in patients. Obesity represents a highly prevalent condition in patients with HIV infection and an important target for intervention.
authors.affiliation: Department of Medicine, University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Tate
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Willig
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.forename: Linda
authors.initials: L
authors.lastname: Moneyham
authors.forename: Mirjam-Colette
authors.initials: MC
authors.lastname: Kempf
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
mesh_terms: D000328:Adult; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000235:genetics / Q000472:pathogenicity; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000139:chemically induced* / Q000453:epidemiology; D050177:Overweight / Q000139:chemically induced / Q000453:epidemiology; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D013997:Time Factors
chemical_list: D017320:HIV Protease Inhibitors; D012367:RNA, Viral