title: Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010.
abstract: OBJECTIVE
  Adipose tissue affects several aspects of the cellular immune system, but prior epidemiological studies have differed on whether a higher body mass index (BMI) promotes CD4 T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count.
  
  
  METHODS
  We used the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data set to analyse the relationship between pre-treatment BMI and 12-month CD4 T-cell recovery among adults who started ART between 1998 and 2010 and maintained HIV-1 RNA levels < 400 copies/mL for at least 6 months. Multivariable regression models were adjusted for age, race, sex, baseline CD4 count and HIV RNA level, year of ART initiation, ART regimen and clinical site.
  
  
  RESULTS
  A total of 8381 participants from 13 cohorts contributed data; 85% were male, 52% were nonwhite, 32% were overweight (BMI 25-29.9 kg/m(2) ) and 15% were obese (BMI > 30 kg/m(2) ). Pretreatment BMI was associated with 12-month CD4 T-cell change (P < 0.001), but the relationship was nonlinear (P < 0.001). Compared with a reference of 22 kg/m(2) , a BMI of 30 kg/m(2) was associated with a 36 cells/μL [95% confidence interval (CI) 14, 59 cells/μL] greater CD4 T-cell count recovery among women and a 19 cells/μL (95% CI 9, 30 cells/μL) greater recovery among men at 12 months. At a BMI > 30 kg/m(2) , the observed benefit was attenuated among men to a greater degree than among women, although this difference was not statistically significant.
  
  
  CONCLUSIONS
  A BMI of approximately 30 kg/m(2) at ART initiation was associated with greater CD4 T-cell recovery at 12 months compared with higher or lower BMI values, suggesting that body composition may affect peripheral CD4 T-cell recovery.
authors.affiliation: Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Koethe
authors.affiliation: Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Jenkins
authors.affiliation: Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: B
authors.initials: B
authors.lastname: Lau
authors.affiliation: Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Silverberg
authors.affiliation: Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: T T
authors.initials: TT
authors.lastname: Brown
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Blashill
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Anema
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Willig
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Stinnette
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, AB, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.affiliation: Center for AIDS Research, University of Washington, Seattle, WA, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Sterling
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D066264:Datasets as Topic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; antiretroviral therapy; immune reconsitition; nutrition; obesity