Obesity Trends and Body Mass Index Changes After Starting Antiretroviral Treatment: The Swiss HIV Cohort Study.
BACKGROUND
The factors that contribute to increasing obesity rates in human immunodeficiency virus (HIV)-positive persons and to body mass index (BMI) increase that typically occurs after starting antiretroviral therapy (ART) are incompletely characterized.


METHODS
We describe BMI trends in the entire Swiss HIV Cohort Study (SHCS) population and investigate the effects of demographics, HIV-related factors, and ART on BMI change in participants with data available before and 4 years after first starting ART.


RESULTS
In the SHCS, overweight/obesity prevalence increased from 13% in 1990 (n = 1641) to 38% in 2012 (n = 8150). In the participants starting ART (n = 1601), mean BMI increase was 0.92 kg/m(2) per year (95% confidence interval, .83-1.0) during year 0-1 and 0.31 kg/m(2) per year (0.29-0.34) during years 1-4. In multivariable analyses, annualized BMI change during year 0-1 was associated with older age (0.15 [0.06-0.24] kg/m(2)) and CD4 nadir <199 cells/µL compared to nadir >350 (P < .001). Annualized BMI change during years 1-4 was associated with CD4 nadir <100 cells/µL compared to nadir >350 (P = .001) and black compared to white ethnicity (0.28 [0.16-0.37] kg/m(2)). Individual ART combinations differed little in their contribution to BMI change.


CONCLUSIONS
Increasing obesity rates in the SHCS over time occurred at the same time as aging of the SHCS population, demographic changes, earlier ART start, and increasingly widespread ART coverage. Body mass index increase after ART start was typically biphasic, the BMI increase in year 0-1 being as large as the increase in years 1-4 combined. The effect of ART regimen on BMI change was limited.
Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich and University of Zurich , Switzerland.
Barbara
B
Hasse
Infectious Diseases Service , Kantonsspital Baselland, University of Basel , Bruderholz , Switzerland.
Martin
M
Iff
Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich and University of Zurich , Switzerland.
Bruno
B
Ledergerber
Division of Infectious Diseases , University Hospital Geneva , Switzerland.
Alexandra
A
Calmy
Division of Infectious Diseases , Cantonal Hospital , St. Gallen , Switzerland.
Patrick
P
Schmid
Division of Infectious Diseases , University Hospital Bern , Switzerland.
Christoph
C
Hauser
Division of Infectious Diseases , Centre Hospitalier Universitaire Vaudois and University of Lausanne , Switzerland.
Matthias
M
Cavassini
Division of Infectious Diseases , Regional Hospital , Lugano , Switzerland.
Enos
E
Bernasconi
Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel , Switzerland.
Catia
C
Marzolini
Infectious Diseases Service , Kantonsspital Baselland, University of Basel , Bruderholz , Switzerland.
Philip E
PE
Tarr
V
V
Aubert
J
J
Barth
M
M
Battegay
E
E
Bernasconi
J
J
Böni
H C
HC
Bucher
C
C
Burton-Jeangros
A
A
Calmy
M
M
Cavassini
M
M
Egger
L
L
Elzi
J
J
Fehr
J
J
Fellay
H
H
Furrer
C A
CA
Fux
M
M
Gorgievski
H
H
Günthard
D
D
Haerry
B
B
Hasse
H H
HH
Hirsch
I
I
Hösli
C
C
Kahlert
L
L
Kaiser
O
O
Keiser
T
T
Klimkait
R
R
Kouyos
H
H
Kovari
B
B
Ledergerber
G
G
Martinetti
B
B
Martinez de Tejada
K
K
Metzner
N
N
Müller
D
D
Nadal
G
G
Pantaleo
A
A
Rauch
S
S
Regenass
M
M
Rickenbach
C
C
Rudin
F
F
Schöni-Affolter
P
P
Schmid
D
D
Schultze
J
J
Schüpbach
R
R
Speck
C
C
Staehelin
P
P
Tarr
A
A
Telenti
A
A
Trkola
P
P
Vernazza
R
R
Weber
S
S
Yerly
HIV infection; antiretroviral therapy; body mass index; immunosuppression; longitudinal study; obesity