Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2024 Feb 17;78(2):395-401. doi: 10.1093/cid/ciad545.
Weight gain following initiation of antiretroviral therapy (ART) is common. We assessed the impact of changes in weight in the year following ART initiation with subsequent cardiometabolic disease among AIDS Clinical Trials Group (ACTG) participants.
Linear regression models were fit to examine the association between change in weight/waist circumference (WC) in weeks 0-48 and change in metabolic parameters in weeks 0-48 and 48-96. Cox proportional hazard models were fit to examine the association between changes in weight/WC in weeks 0-48 and diabetes mellitus (DM), metabolic syndrome, or cardiometabolic and cardiovascular events after week 48.
Participants (N = 2624) were primarily male (81%) and non-White (60%). Mean weight gain from 0-48 weeks was 3.6 kg (SD 7.3); 130 participants developed DM; 360 metabolic syndrome; 424 any cardiometabolic event; 28 any cardiovascular event, over 480 weeks of follow-up. In adjusted models, total cholesterol increased by 0.63 mg/dL (95% confidence interval [CI] [.38, .089]) and LDL by 0.39 mg/dL (0.19, 0.59) per 1 kg increase in weight from weeks 0 to48. Participants who experienced >10% weight gain (vs -5% to 5%) had an increased risk of DM (hazard ratio [HR] 2.01, 95% CI [1.30, 3.08]), metabolic syndrome (HR 2.24, 95% CI [1.55, 2.62]), and cardiometabolic outcomes (HR 1.54, 95% CI [1.22, 1.95]). Participants who lost more than 5% of their baseline weight had a lower risk of incident metabolic syndrome (HR 0.67, 95% CI [0.42, 1.07]). Trends for WC were similar.
Weight and body composition changes in the first year following ART initiation are associated with contemporaneous changes in metabolic parameters and subsequent cardiometabolic disease.
在开始抗逆转录病毒疗法（ART）后，体重增加是常见的。我们评估了在开始 ART 后一年内体重变化对艾滋病临床试验组（ACTG）参与者随后发生心血管代谢疾病的影响。
线性回归模型用于检查 0-48 周内体重/腰围（WC）变化与 0-48 周和 48-96 周内代谢参数变化之间的关联。Cox 比例风险模型用于检查 0-48 周内体重/WC 变化与糖尿病（DM）、代谢综合征或心血管代谢和心血管事件之间的关联。
参与者（N=2624）主要为男性（81%）和非白人（60%）。从 0-48 周的平均体重增加为 3.6 公斤（SD 7.3）；130 名参与者发生 DM；360 名代谢综合征；424 名任何心血管代谢事件；28 名任何心血管事件，随访 480 周以上。在调整后的模型中，体重从 0 到 48 周每增加 1 公斤，总胆固醇增加 0.63 毫克/分升（95%置信区间[CI] [0.38，0.089]），LDL 增加 0.39 毫克/分升（0.19，0.59）。与体重减少 5%至 5%相比，体重增加>10%的参与者发生 DM（危险比[HR] 2.01，95%CI [1.30，3.08]）、代谢综合征（HR 2.24，95%CI [1.55，2.62]）和心血管代谢结局（HR 1.54，95%CI [1.22，1.95]）的风险增加。体重减轻超过 5%的参与者发生代谢综合征的风险较低（HR 0.67，95%CI [0.42，1.07]）。WC 的趋势相似。
ART 开始后第一年的体重和身体成分变化与同期代谢参数的变化和随后的心血管代谢疾病有关。
