Martinez S S, Campa A, Bussmann H, Moyo S, Makhema J, Huffman F G, Williams O D, Essex M, Marlink R, Baum M K
1Robert Stempel College of Public Health and Social Work,Florida International University,Miami,FL 33186,USA.
2Botswana Harvard AIDS Initiative Partnership,Gaborone,Botswana.
Br J Nutr. 2016 Jun;115(12):2114-21. doi: 10.1017/S0007114516001409. Epub 2016 Apr 18.
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.
包括艾滋病病毒（HIV）在内，在许多疾病中都提出了肥胖悖论。为调查肥胖及其对HIV疾病进展的影响而开展的研究尚无定论，且非洲地区缺乏相关研究。本研究在博茨瓦纳对未接受抗逆转录病毒治疗（ART）的HIV阳性无症状成年人进行了为期18个月的超重/肥胖（体重指数（BMI）≥25kg/m²）与HIV疾病进展关系的调查。一项针对无症状、未接受ART治疗的HIV阳性成年人的队列研究纳入了217名参与者，其中139人体重指数为18.0 - 24.9kg/m²，78人体重指数≥25kg/m²。主要结局是随访18个月期间达到事件发生的时间（分化簇4（CD4）细胞计数下降≥25%）；次要结局是CD4细胞计数<250个/µl以及出现艾滋病定义疾病的时间。使用比例生存风险模型比较18个月内HIV疾病进展至事件发生时间的风险比（HR）。较高的基线BMI与随访期间艾滋病定义疾病的风险显著降低相关（HR 0.218；95%置信区间0.068，0.701；P = 0.011）。基线时较高的脂肪量也与随访期间艾滋病定义疾病的风险降低显著相关（HR 0.855；95%置信区间0.741，0.987；P = 0.033），以及与CD4细胞计数≤250/µl和艾滋病定义疾病两者中较早发生者的联合结局相关（HR 0.918；95%置信区间0.847，0.994；P = 0.036）。所有模型均针对协变量进行了校正。在未接受ART治疗的HIV感染参与者中，较高的BMI和脂肪量与疾病进展较慢相关。需要进行机制研究以评估BMI、脂肪量与HIV疾病进展之间的关联。
