Increasing Obesity in Treated Female HIV Patients from Sub-Saharan Africa: Potential Causes and Possible Targets for Intervention.

Claire L Mccormick,Mark Pakianathan,Helen Webb,Kim Iliffe,Derek C Macallan,Catherine J Douch,Arianne M Francis

doi:10.3389/fimmu.2014.00507

Abstract

Objectives: To investigate changing nutritional demographics of treated HIV-1-infected patients and explore causes of obesity, particularly in women of African origin.Methods: We prospectively reviewed nutritional demographics of clinic attenders at an urban European HIV clinic during four one-month periods at three-yearly intervals (2001, 2004, 2007, and 2010) and in two consecutive whole-year reviews (2010–2011 and 2011–2012). Risk-factors for obesity were assessed by multiple linear regression. A sub-study of 50 HIV-positive African female patients investigated body-size/shape perception using numerical, verbal, and pictorial cues.Results: We found a dramatic rise in the prevalence of obesity (BMI > 30 kg/m2), from 8.5 (2001) to 28% (2011–2012) for all clinic attenders, of whom 86% were on antiretroviral treatment. Women of African origin were most affected, 49% being obese, with a further 32% overweight (BMI 25–30 kg/m2) in 2012. Clinical factors strongly associated with obesity included female gender, black African ethnicity, non-smoking, age, and CD4 count (all P < 0.001); greater duration of cART did not predict obesity. Individual weight-time trends mostly showed slow long-term progressive weight gain. Investigating body-weight perception, we found that weight and adiposity were underestimated by obese subjects, who showed a greater disparity between perceived and actual adiposity (P < 0.001). Obese subjects targeted more obese target “ideal” body shapes (P < 0.01), but were less satisfied with their body shape overall (P = 0.02).Conclusion: Seropositive African women on antiretroviral treatment are at heightened risk of obesity. Although multifactorial, body-weight perception represents a potential target for intervention.

Highlights

When the HIV/AIDS pandemic emerged in the 1980’s wasting represented the major metabolic consequence of the disease [1] and was recognized as an AIDS-defining criterion
We found a dramatic rise in the prevalence of obesity (BMI > 30 kg/m2), from 8.5 (2001) to 28% (2011–2012) for all clinic attenders, of whom 86% were on antiretroviral treatment
Clinical factors strongly associated with obesity included female gender, black African ethnicity, non-smoking, age, and CD4 count; greater duration of combination antiretroviral treatment (cART) did not predict obesity

Summary

Introduction

When the HIV/AIDS pandemic emerged in the 1980’s wasting represented the major metabolic consequence of the disease [1] and was recognized as an AIDS-defining criterion. Treatment regimes were associated with other metabolic sequelae, most notably HIV-associated lipodystrophy syndrome (HALS). The visceral adiposity associated with HALS is of particular concern because of its association with insulin resistance, diabetes, and cardiovascular disease, effects which may be compounded by the effects of cART itself [4, 5]. Obesity, which represents an entity distinct from visceral lipodystrophy [10], has recently been reported in several HIVpositive cohorts [2, 7, 8, 11, 12]. There is evidence that black African ethnicity and female gender increase the risk of weight gain on cART [2, 11, 13, 14], most studies regarding African ethnicity have focused on African-American populations [15, 16]

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