Weight changes, metabolic syndrome and all‐cause mortality among Asian adults living with HIV
Win Min Han, Matthew Law, Jun Yong Choi, Rossana Ditangco, Nagalingeswaran Kumarasamy, Romanee Chaiwarith, Penh Sun Ly, Suwimon Khusuwan, Tuti Parwati Merati, Cuong Duy, Evy Yunihastuti, Iskandar Azwa, Man‐Po Lee, Thach Ngoc Pham, Yu‐Jiun Chan, Sasisopin Kiertiburanakul, Oon Tek Ng, Junko Tanuma, Sanjay Pujari, Fujie Zhang, Yasmin Gani, Vidya Mave, Jeremy Ross, Anchalee Avihingsanon, the TREAT Asia HIV Observational Database of IeDEA Asia‐Pacific
Abstract
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: , 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.