1 Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center , Omaha, Nebraska.
2 Statistical Data Analysis Center , Harvard School of Public Health, Boston, Massachusetts.
J Womens Health (Larchmt). 2018 Sep;27(9):1162-1169. doi: 10.1089/jwh.2017.6717. Epub 2018 Apr 2.
Obesity is prevalent among HIV-infected individuals on antiretroviral therapy (ART). Cross-sectional studies have suggested that HIV-infected women are more likely to be overweight than men, but observational studies evaluating sex differences in body mass index (BMI) increases following ART initiation are conflicting.
We pooled data from three randomized clinical trials of ART initiation in persons with HIV in the United States. BMIs were compared between 760 women and 3041 men to test whether BMI changes in the first 96 weeks following initiation of ART differed by sex at birth. Linear regression estimated the relationship between sex and change in BMI from pre-ART initiation to week 96.
After 96 weeks, women gained an average of 1.91 kg/m (95% confidence interval [CI] 1.64-2.19), men gained an average of 1.39 kg/m (95% CI 1.30-1.48); p for sex difference <0.001; the sex difference persisted within each pre-ART initiation BMI subgroup. After adjusting for pre-ART initiation age, CD4+ count, HIV-1 viral load, race/ethnicity, study, and ART regimen, mean BMI change for women was 0.59 kg/m (95% CI 0.37-0.81) more than for men (p < 0.001). Statistical interactions were observed between sex and both pre-ART CD4+ count and HIV-1 viral load and suggest that for subgroups with higher viral load and lower CD4+ at baseline, the estimated BMI changes in women are even larger than the average estimated difference.
HIV-1-infected women experienced a significantly greater increase in BMI following ART initiation than men. These differences are a problem of clinical significance to women living with HIV.
在接受抗逆转录病毒疗法 (ART) 的艾滋病毒感染者中，肥胖症较为普遍。横断面研究表明，与男性相比，感染艾滋病毒的女性更容易超重，但评估抗逆转录病毒治疗开始后体重指数 (BMI) 增加的观察性研究结果存在差异。
我们汇总了在美国进行的三项艾滋病毒感染者开始接受抗逆转录病毒治疗的随机临床试验的数据。将 760 名女性和 3041 名男性的 BMI 进行比较，以检验在开始接受抗逆转录病毒治疗后的前 96 周内，出生时的性别是否会影响 BMI 的变化。线性回归估计了从开始接受抗逆转录病毒治疗前到第 96 周时，性别与 BMI 变化之间的关系。
96 周后，女性平均体重增加 1.91kg/m（95%置信区间 [CI] 1.64-2.19），男性平均体重增加 1.39kg/m（95% CI 1.30-1.48）；性别差异的 p 值<0.001；这种性别差异在每个开始接受抗逆转录病毒治疗前的 BMI 亚组中均存在。在校正了开始接受抗逆转录病毒治疗前的年龄、CD4+计数、HIV-1 病毒载量、种族/民族、研究和抗逆转录病毒治疗方案后，女性的平均 BMI 变化比男性多 0.59kg/m（95% CI 0.37-0.81）（p<0.001）。在开始接受抗逆转录病毒治疗前的 CD4+计数和 HIV-1 病毒载量方面观察到性别与统计交互作用，这表明对于基线病毒载量较高且 CD4+计数较低的亚组，女性的 BMI 变化估计值甚至比平均估计差值还要大。
与男性相比，接受抗逆转录病毒治疗后，HIV-1 感染女性的 BMI 显著增加。这些差异对感染 HIV 的女性来说是一个具有临床意义的问题。
