title: Obesity is associated with race/sex disparities in diabetes and hypertension prevalence, but not cardiovascular disease, among HIV-infected adults.
abstract: Race/sex differences are observed in cardiometabolic disease (CMD) risk and prevalence in the context of treated, chronic HIV infection, and these differences could be exacerbated by disparities in obesity prevalence. We sought to determine the effect of obesity on these disparities among people living with HIV. Prevalence of CMD (dyslipidemia, cardiovascular disorders, hypertension, diabetes, chronic kidney disease) was determined for patients seen at the University of Alabama at Birmingham HIV clinic between 7/2010 and 6/2011. Staged logistic regression was used to examine the impact of race/sex on comorbidities adjusting for key confounders including/excluding obesity (body mass index ≥30 kg/m(2)). Of 1,800 participants, 77% were male, 54% were black, and 25% were obese. Obesity prevalence differed by race/sex: black women 49%, black men 24%, white women 24%, white men 15% (p<0.01). Compared to white men, other groups had reduced odds for dyslipidemia and cardiovascular disorders (p<0.01). Black men had increased odds for hypertension and chronic kidney disease, while black women had a nearly 2-fold increased odds for diabetes and hypertension (all at p<0.01). The associations of black women with diabetes and hypertension were attenuated when obesity was included in the models. Other group differences remained significant. Disparities in obesity prevalence do not explain race/sex differences in all CMD among people with HIV. Obesity accounted for associations with diabetes/hypertension for black women, who may benefit from weight reduction to decrease disease risk. Further investigations into the etiology and treatment of CMD in people living with HIV should consider unique race/sex treatment issues.
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Willig
authors.affiliation: 2 Department of Biostatistics, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: E Turner
authors.initials: ET
authors.lastname: Overton
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Greer A
authors.initials: GA
authors.lastname: Burkholder
authors.affiliation: 3 School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: David
authors.initials: D
authors.lastname: Kim
authors.affiliation: 4 Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Eric
authors.initials: E
authors.lastname: Chamot
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.affiliation: 5 Division of Infectious Diseases, University of Washington , Seattle, Washington.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.affiliation: 1 Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D044383:Black People; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D012737:Sex Factors; D044465:White People; D001741:Black or African American