Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Merck & Co., Inc., Kenilworth, New Jersey, USA.
AIDS. 2022 Dec 1;36(15):2107-2119. doi: 10.1097/QAD.0000000000003332. Epub 2022 Jul 16.
Weight gain is becoming increasingly prevalent amongst people with HIV (PWH) receiving contemporary antiretroviral treatment. We investigated BMI changes and clinical impact in a large prospective observational study.
PWH aged ≥18 years were included who started a new antiretroviral (baseline) during 2010-2019 with baseline and ≥1 follow-up BMI assessment available. Rates of clinical outcomes (cardiovascular disease [CVD], malignancies, diabetes mellitus [DM] and all-cause mortality) were analysed using Poisson regression to assess effect of time-updated BMI changes (>1 kg/m 2 decrease, ±1 kg/m 2 stable, >1 kg/m 2 increase), lagged by 1-year to reduce reverse causality. Analyses were adjusted for baseline BMI plus key confounders including antiretroviral exposure.
6721 PWH were included; 72.3% were male, median age 48 years (interquartile range [IQR] 40-55). At baseline, 8.4% were antiretroviral-naive, and 5.0% were underweight, 59.7% healthy weight, 27.5% overweight, and 7.8% were living with obesity. There was an 8.2% increase in proportion of overweight and 4.8% in obesity over the study period (median follow-up 4.4 years [IQR 2.6-6.7]).100 CVDs, 149 malignancies, 144 DMs, and 257 deaths were observed with incidence rates 4.4, 6.8, 6.6, 10.6 per 1000 person-years of follow-up, respectively. Compared to stable BMI, >1 kg/m 2 increase was associated with increased risk of DM (adjusted incidence rate ratio [IRR]: 1.96, 95% confidence interval [CI]: 1.36-2.80) and >1 kg/m 2 decrease with increased risk of death (adjusted IRR: 2.33, 95% CI: 1.73-3.13). No significant associations were observed between BMI changes and CVD or malignancies.
A BMI increase was associated with DM and a decrease associated with death.
在接受当代抗逆转录病毒治疗的 HIV（艾滋病毒）感染者中，体重增加的现象越来越普遍。我们在一项大型前瞻性观察研究中调查了 BMI 的变化及其临床影响。
纳入年龄≥18 岁的新开始抗逆转录病毒治疗（基线）的 HIV 感染者，在 2010 年至 2019 年期间，基线和至少 1 次随访 BMI 评估均可用。使用泊松回归分析评估临床结局（心血管疾病[CVD]、恶性肿瘤、糖尿病[DM]和全因死亡率）的发生率，以评估时间更新 BMI 变化（>1kg/m2 下降、±1kg/m2 稳定、>1kg/m2 增加）的影响，滞后 1 年以减少反向因果关系。分析调整了基线 BMI 加上关键混杂因素，包括抗逆转录病毒暴露。
共纳入 6721 名 HIV 感染者；72.3%为男性，中位年龄 48 岁（四分位距 [IQR] 40-55）。基线时，8.4%为抗逆转录病毒初治者，5.0%为体重不足，59.7%为健康体重，27.5%为超重，7.8%为肥胖。研究期间超重比例增加 8.2%，肥胖比例增加 4.8%（中位随访时间 4.4 年[IQR 2.6-6.7]）。观察到 100 例 CVD、149 例恶性肿瘤、144 例 DM 和 257 例死亡，相应的发病率分别为每 1000 人年 4.4、6.8、6.6、10.6 例。与 BMI 稳定相比，>1kg/m2 的增加与 DM 的风险增加相关（调整后的发病率比[IRR]：1.96，95%置信区间[CI]：1.36-2.80），而>1kg/m2 的减少与死亡风险增加相关（调整后的 IRR：2.33，95%CI：1.73-3.13）。BMI 变化与 CVD 或恶性肿瘤之间未观察到显著关联。
BMI 增加与 DM 相关，减少与死亡相关。
