title: Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana.
abstract: An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0-24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count<250 cells/µl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0·218; 95 % CI 0·068, 0·701; P=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.
authors.affiliation: 1Robert Stempel College of Public Health and Social Work,Florida International University,Miami,FL 33186,USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Martinez
authors.affiliation: 1Robert Stempel College of Public Health and Social Work,Florida International University,Miami,FL 33186,USA.
authors.forename: A
authors.initials: A
authors.lastname: Campa
authors.affiliation: 2Botswana Harvard AIDS Initiative Partnership,Gaborone,Botswana.
authors.forename: H
authors.initials: H
authors.lastname: Bussmann
authors.affiliation: 2Botswana Harvard AIDS Initiative Partnership,Gaborone,Botswana.
authors.forename: S
authors.initials: S
authors.lastname: Moyo
authors.affiliation: 2Botswana Harvard AIDS Initiative Partnership,Gaborone,Botswana.
authors.forename: J
authors.initials: J
authors.lastname: Makhema
authors.affiliation: 1Robert Stempel College of Public Health and Social Work,Florida International University,Miami,FL 33186,USA.
authors.forename: F G
authors.initials: FG
authors.lastname: Huffman
authors.affiliation: 1Robert Stempel College of Public Health and Social Work,Florida International University,Miami,FL 33186,USA.
authors.forename: O D
authors.initials: OD
authors.lastname: Williams
authors.affiliation: 3Harvard School of Public Health,Boston,MA 02115,USA.
authors.forename: M
authors.initials: M
authors.lastname: Essex
authors.affiliation: 3Harvard School of Public Health,Boston,MA 02115,USA.
authors.forename: R
authors.initials: R
authors.lastname: Marlink
authors.affiliation: 1Robert Stempel College of Public Health and Social Work,Florida International University,Miami,FL 33186,USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Baum
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000517:prevention & control; D000273:Adipose Tissue / Q000378:metabolism*; D000328:Adult; D019380:Anti-HIV Agents; D001823:Body Composition; D015992:Body Mass Index; D001902:Botswana; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D016016:Proportional Hazards Models; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: ART antiretroviral treatment; Antiretroviral treatment naïve adults; BMI; Bioelectrical impedance analyses; Body composition; CD4 cluster of differentiation 4; CD8 cluster of differentiation 8; Disease progression; HIV infection; HR hazard ratio