Weight changes, metabolic syndrome and all-cause mortality among Asian adults living with HIV

the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific

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Objectives: We investigated weight changes following antiretroviral therapy (ART) initiation, the development of metabolic syndrome (MetS) and its association with all-cause mortality among Asian adults living with HIV. Methods: Participants enrolled in a regional Asian HIV-infected cohort with weight and height measurements at ART initiation were eligible for inclusion in the analysis. Factors associated with weight changes and incident MetS (according to the International Diabetic Federation (IDF) definition) were analysed using linear mixed models and Cox regression, respectively. Competing-risk regression models were used to investigate the association of MetS with all-cause mortality. Results: Among 4931 people living with HIV (PLWH), 66% were male. At ART initiation, the median age was 34 [interquartile range (IQR) 29–41] years, and the median (IQR) weight and body mass index (BMI) were 55 (48–63) kg and 20.5 (18.4–22.9) kg/m2, respectively. At 1, 2 and 3 years of ART, overall mean (± standard deviation) weight gain was 2.2 (±5.3), 3.0 (±6.2) and 3.7 (±6.5) kg, respectively. Participants with baseline CD4 count ≤ 200 cells/µL [weight difference (diff) = 2.2 kg; 95% confidence interval (CI) 1.9–2.5 kg] and baseline HIV RNA ≥ 100 000 HIV-1 RNA copies/mL (diff = 0.6 kg; 95% CI 0.2–1.0 kg), and those starting with integrase strand transfer inhibitor (INSTI)-based ART (diff = 2.1 kg; 95% CI 0.7–3.5 kg vs. nonnucleoside reverse transcriptase inhibitors) had greater weight gain. After exclusion of those with abnormal baseline levels of MetS components, 295/3503 had incident MetS [1.18 (95% CI 1.05–1.32)/100 person-years (PY)]. The mortality rate was 0.7 (95% CI 0.6–0.8)/100 PY. MetS was not significantly associated with all-cause mortality in the adjusted model (P = 0.236). Conclusions: Weight gain after ART initiation was significantly higher among those initiating ART with lower CD4 count, higher HIV RNA and an INSTI-based regimen after controlling for baseline BMI. Greater efforts to identify and manage MetS among PLWH are needed.

Original languageEnglish
Pages (from-to)274-286
Number of pages13
JournalHIV Medicine
Issue number3
Publication statusPublished - 2022 Mar

Bibliographical note

Funding Information:
This work was supported by the US National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above.

Funding Information:
P. S. Ly*, V. Khol, National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia; F. J. Zhang*, H. X. Zhao, N. Han, Beijing Ditan Hospital, Capital Medical University, Beijing, China; M. P. Lee*, P. C. K. Li, T. S. Kwong, T. H. Li, Queen Elizabeth Hospital, Hong Kong SAR; N. Kumarasamy*, C. Ezhilarasi, Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS‐Infectious Diseases Medical Centre, VHS, Chennai, India; S.Pujari *, K. Joshi, S. Gaikwad, A. Chitalikar, Institute of Infectious Diseases, Pune, India; S. Sangle*, V. Mave, I. Marbaniang, S. Nimkar, BJ Government Medical College and Sassoon General Hospital, Pune, India; T. P. Merati*, D. N. Wirawan, F. Yuliana, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia; E. Yunihastuti*, A. Widhani, S. Maria, T. H. Karjadi, Faculty of Medicine Universitas Indonesia ‐ Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; J. Tanuma*, S. Oka, T. Nishijima, National Center for Global Health and Medicine, Tokyo, Japan; J. Y. Choi*, S. Na, J. M. Kim, Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Y. M. Gani*, N. B. Rudi, Hospital Sungai Buloh, Sungai Buloh, Malaysia; I. Azwa*, A. Kamarulzaman, S. F. SyedOmar, S. Ponnampalavanar, University Malaya Medical Centre, Kuala Lumpur, Malaysia; R. Ditangco*, M. K. Pasayan, M. L. Mationg, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; Y. J. Chan*, W. W. Ku, P. C. Wu, E. Ke, Taipei Veterans General Hospital, Taipei, Taiwan; O. T. Ng*, P. L. Lim, L. S. Lee, T. Yap, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore [Note: O. T. Ng is also supported by the Singapore Ministry of Health’s (MOH) National Medical Research Council (NMRC) Clinician Scientist Award (MOH‐000276). Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not reflect the views of MOH/NMRC]; A. Avihingsanon*, S. Gatechompol, P. Phanuphak, C. Phadungphon, HIV‐NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; S. Kiertiburanakul*, A. Phuphuakrat, L. Chumla, N. Sanmeema, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; R. Chaiwarith*, T. Sirisanthana, J. Praparattanapan, K. Nuket, Research Institute for Health Sciences, Chiang Mai, Thailand; S. Khusuwan*, P. Payoong, P. Kantipong, P. Kambua, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; T. N. Pham*, K. V. Nguyen, D. T. H. Nguyen, D. T. Nguyen, National Hospital for Tropical Diseases, Hanoi, Vietnam; C. D. Do*, A. V. Ngo, L. T. Nguyen, Bach Mai Hospital, Hanoi, Vietnam; A. H. Sohn*, J. L. Ross*, B. Petersen, TREAT Asia, amfAR ‐ The Foundation for AIDS Research, Bangkok, Thailand; M. G. Law*, A. Jiamsakul*, D. Rupasinghe, The Kirby Institute, UNSW Sydney, NSW, Australia.

Publisher Copyright:
© 2021 British HIV Association.

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)


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