title: High risk of obesity and weight gain for HIV-infected uninsured minorities.
abstract: BACKGROUND
  Obesity and HIV disproportionately affect minorities and have significant health risks, but few studies have examined disparities in weight change in HIV-seropositive (HIV+) cohorts.
  
  
  OBJECTIVE
  To determine racial and health insurance disparities in significant weight gain in a predominately Hispanic HIV+ cohort.
  
  
  METHODS
  Our observational cohort study of 1214 nonunderweight HIV+ adults from 2007 to 2010 had significant weight gain [≥3% annual body mass index (BMI) increase] as the primary outcome. The secondary outcome was continuous BMI over time. A 4-level race-ethnicity/insurance predictor reflected the interaction between race-ethnicity and insurance: insured white (non-Hispanic), uninsured white, insured minority (Hispanic or black), or uninsured minority. Logistic and mixed-effects models adjusted for baseline BMI, age, gender, household income, HIV transmission category, antiretroviral therapy type, CD4 count, plasma HIV-1 RNA, observation months, and visit frequency.
  
  
  RESULTS
  The cohort was 63% Hispanic and 14% black; 13.3% were insured white, 10.0% uninsured white, 40.9% insured minority, and 35.7% uninsured minority. At baseline, 37.5% were overweight, 22.1% obese. Median observation was 3.25 years. Twenty-four percent of the cohort had significant weight gain, which was more likely for uninsured minority patients than insured whites [adjusted odds ratio = 2.85, 95% confidence intervals (CIs): 1.66 to 4.90]. The rate of BMI increase in mixed-effects models was greatest for uninsured minorities. Of 455 overweight at baseline, 29% were projected to become obese in 4 years.
  
  
  CONCLUSIONS
  In this majority Hispanic HIV+ cohort, 60% were overweight or obese at baseline, and uninsured minority patients gained weight more rapidly. These data should prompt greater attention by HIV providers for prevention of obesity.
authors.affiliation: *Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX; †Research to Advance Community Health (ReACH), University of Texas Health Science Center San Antonio, San Antonio, TX; ‡University of Texas School of Public Health, San Antonio Regional Campus, San Antonio, TX; §Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, TX; ‖Division of Infectious Diseases, Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX; and ¶Department of Family & Community Health Systems, School of Nursing, University of Texas Health Science Center San Antonio, San Antonio, TX.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Taylor
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Liang
authors.forename: L Sergio
authors.initials: LS
authors.lastname: Garduño
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walter
authors.forename: Margit B
authors.initials: MB
authors.lastname: Gerardi
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Anstead
authors.forename: Delia
authors.initials: D
authors.lastname: Bullock
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008913:Minority Groups; D009765:Obesity / Q000453:epidemiology*; D018570:Risk Assessment; D015430:Weight Gain