Relationship between Body Mass Index and Mortality in HIV-Infected HAART Users in the Women's Interagency HIV Study.

Anjali Sharma,Donald R Hoover,Michael W Plankey,Ronald C Hershow,Elizabeth T Golub,Deborah Gustafson,Kathryn Anastos,Qiuhu Shi,Phyllis C Tien,Antonio Guilherme Pacheco

doi:10.1371/journal.pone.0143740

Abstract

BackgroundEarly HIV studies suggested protective associations of overweight against mortality, yet data are lacking for the era of potent highly active antiretroviral therapy (HAART). We evaluated associations of pre-HAART initiation body mass index (BMI) with mortality among HAART-using women.MethodsProspective study of time to death after HAART initiation among continuous HAART users in the Women’s Interagency HIV Study. Unadjusted Kaplan–Meier and adjusted proportional hazards survival models assessed time to AIDS and non-AIDS death by last measured pre-HAART BMI.ResultsOf 1428 continuous HAART users 39 (2.7%) were underweight, 521 (36.5%) normal weight, 441 (30.9%) overweight, and 427 (29.9%) obese at time of HAART initiation. A total of 322 deaths occurred during median follow-up of 10.4 years (IQR 5.9–14.6). Censoring at non-AIDS death, the highest rate of AIDS death was observed among underweight women (p = 0.0003 for all 4 categories). In multivariate models, women underweight prior to HAART died from AIDS more than twice as rapidly vs. normal weight women (aHR 2.04, 95% CI 1.03, 4.04); but being overweight or obese (vs. normal weight) was not independently associated with AIDS death. Cumulative incidence of non-AIDS death was similar across all pre-HAART BMI categories.ConclusionsAmong continuous HAART-using women, being overweight prior to initiation was not associated with lower risk of AIDS or non-AIDS death. Being underweight prior to HAART was associated with over double the rate of AIDS death in adjusted analyses. Although overweight and obesity may be associated with many adverse health conditions, neither was predictive of mortality among the HAART-using women.

Highlights

Wasting, commonly experienced by people living with HIV early in the epidemic, is rare [1, 2] whereas obesity and overweight are common nutritional problems for HIV-infected adults in the United States
Women underweight prior to highly active antiretroviral therapy (HAART) died from AIDS more than twice as rapidly vs. normal weight women; but being overweight or obese was not PLOS ONE | DOI:10.1371/journal.pone
A recent systematic review and meta-analysis found that in the general U.S population, overweight was associated with lower all-cause mortality compared with normal weight, whereas obesity and morbid obesity were associated with higher all-cause mortality [13]

Summary

Introduction

Commonly experienced by people living with HIV early in the epidemic, is rare [1, 2] whereas obesity and overweight are common nutritional problems for HIV-infected adults in the United States. A report from the Women's Interagency HIV Study (WIHS) indicated that being overweight, obese, or morbidly obese was independently associated with higher CD4+ count, total lymphocyte count, and WBC counts compared to those of normal body mass index (BMI) (18.5–24.9 kg/m2) women. Studies of mortality risk conducted among HIV-infected populations even earlier in the HIV epidemic suggested protective associations of overweight against mortality [10,11,12]; it is unclear whether this extends into the current era of potent antiretroviral therapy. We undertook this study to assess the association between BMI and risk of AIDS-specific and non-AIDS mortality among HIVinfected women regularly taking highly active antiretroviral therapy (HAART), which is currently recommended for all HIV-infected persons in the U.S [14]. HIV studies suggested protective associations of overweight against mortality, yet data are lacking for the era of potent highly active antiretroviral therapy (HAART). We evaluated associations of pre-HAART initiation body mass index (BMI) with mortality among HAART-using women

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