title: Weight change after antiretroviral therapy and mortality.
abstract: BACKGROUND
  Weight gain after antiretroviral therapy (ART) initiation is common, but its implication for mortality is unknown. We evaluated weight change in the first year after ART initiation and its association with subsequent mortality.
  
  
  METHODS
  Human immunodeficiency virus-infected patients from the Veterans Aging Cohort Study (VACS) who initiated ART between 2000 and 2008, with weight recorded at baseline and 1 year later, were followed another 5 years for mortality. Baseline body mass index (BMI) was classified as underweight (<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (≥30 kg/m(2)). We used multivariable Cox models to assess mortality risk with adjustment for disease severity using the VACS Index.
  
  
  RESULTS
  The sample consisted of 4184 men and 127 women with a mean age of 47.9 ± 10.0 years. After 1 year of ART, median weight change was 5.9 pounds (2.7 kg) (interquartile range, -2.9 to 17.0 pounds, -1.3 to 7.7 kg). Weight gain after ART initiation was associated with lower mortality among underweight and normal-weight patients. A minimum threshold of 10- to 19.9-pound (4.5 to 9.0 kg) weight gain was beneficial for normal-weight patients (hazard ratio, 0.56; 95% confidence interval, .41-.78), but there was no clear benefit to weight gain for overweight/obese patients. Baseline weight, CD4 cell count status, and hemoglobin level were strongly associated with weight gain. Risk for weight gain was higher among those with greater disease severity, regardless of weight at initiation.
  
  
  CONCLUSIONS
  The survival benefits of weight gain after ART initiation are dependent on starting BMI. Weight gain after ART is associated with lower mortality for those who are not initially overweight.
authors.affiliation: Yale University School of Medicine, New Haven.
authors.forename: Bianca
authors.initials: B
authors.lastname: Yuh
authors.affiliation: Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven.
authors.forename: Janet
authors.initials: J
authors.lastname: Tate
authors.affiliation: VA Pittsburgh Healthcare System University of Pittsburgh School of Medicine, Pennsylvania.
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.affiliation: University of Washington School of Medicine, Seattle.
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.affiliation: VA Pittsburgh Healthcare System University of Pittsburgh School of Medicine, Pennsylvania.
authors.forename: Matthew
authors.initials: M
authors.lastname: Freiberg
authors.affiliation: UCLA School of Medicine Greater Los Angeles VA Healthcare System, California.
authors.forename: David
authors.initials: D
authors.lastname: Leaf
authors.affiliation: University of Minnesota Medical School, Minneapolis.
authors.forename: Mary
authors.initials: M
authors.lastname: Logeais
authors.affiliation: Atlanta VA Medical Center Emory University School of Medicine, Atlanta, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.affiliation: Michael E. Debakey VA Medical Center Baylor College of Medicine, Houston, Texas.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.affiliation: Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ruser
authors.affiliation: Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight; D011446:Prospective Studies; D014728:Veterans; D015430:Weight Gain / Q000187:drug effects*; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D044966:Anti-Retroviral Agents
keywords: BMI; HIV; antiretroviral therapy; veterans; weight