Obesity in HIV After Antiretroviral Therapy

Changes in Overweight/Obesity Status, hsCRP, and D-dimer in HIV-infected Patients After 12 Months of Initial Antiretroviral Treatment

This is a retrospective longitudinal study that evaluates the prevalence and incidence of overweight/obesity within an HIV-infected population before and after 12 and 24 months of a stable antiretroviral therapy (ART). The study group will be compared to the weight of a healthy, matched population that is not infected with HIV. The primary hypothesis states that the proportion of HIV-infected persons newly classified as overweight/obese will increase by ≥20% after 12 months of initial ART, and this incidence will be greater than that of a matched HIV-uninfected control population. The effect of immune function variables, such as CD4, HIV viral load, and ART regimen on weight will be analyzed. In addition, the study will analyze the effect of weight and immune function markers on the inflammatory markers, high sensitivity C-reactive protein (hsCRP) and D-dimer. An HIV samples repository will be used for specimens to be assayed for hsCRP and D-dimer.

Study Overview

• Status: Completed
• Conditions: Obesity; HIV; AIDS
• Intervention / Treatment: Drug: antiretroviral therapy

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adult subjects (≥ 18 years of age) infected with HIV-1 treated in the Infectious Disease Clinic at Duke University Medical Center between 3/1/98 to 3/1/08 who meet eligibility criteria.

Adult subjects (≥ 18 years of age), followed in primary care clinics within the Duke Health System between 3/1/98 to 3/1/08, who meet eligibility criteria. Control subjects must have data for weight 12 months after baseline visit.

Description

Inclusion Criteria:

• Inclusion Criteria for HIV-infected cohort:

  1. Treatment-naive at study entry;
  2. Subjects will need to remain on ART for 12 months as initiated with substitution allowed for toxicity management within the same class of drug;
  3. Subjects within this group that remain on ART for an additional 12 months (total 24 months) as initiated with substitution allowed for toxicity management within the same class of drug will continue to be followed longitudinally for the 24 month period;

  4. Availability of repository samples.

     Inclusion Criteria for Control Cohort:

     Followed in the Duke Primary Care Clinics during the years of inclusion with available data on weight, race and gender.

     Exclusion Criteria:

Exclusion Criteria for HIV-infected cohort:

1. Pregnancy during period of observation or within 6 months of study entry;
2. Malignancy (other than squamous or basal cell carcinomas of the skin);
3. Newly diagnosed thyroid disorder within 6 months of study entry;
4. Use of megace or marinol;
5. Long-term use of glucocorticoids (greater than 1 month of prednisone 5mg or higher or an equivalent dose of another glucocorticoid);
6. Use of androgenic steroids;
7. History of diabetes or use of glucose-lowering agents;
8. Use of the following psychiatric or anticonvulsant agents- thioridazine, olanzapine (zyprexa), clozapine (clozaril), quetiapine (seroquel), risperidone (risperdal), lithium, remeron, paxil, valproate, carbamazepine, gabapentin;
9. Concurrent treatment for hepatitis C infection;
10. Diagnosis of a new opportunistic infection (OI) as defined by the CDC during the 1st 12 months of ART.22 OIs include the following: PCP, toxoplasmosis, MAC, histoplasmosis, candidiasis, cryptococcus, coccidiodes, CMV, cryptosporidium, microsporidiosis, tuberculosis, bartonellosis, herpes simplex virus, HHV-8, human papillomavirus;
11. Diagnosis of congestive heart failure and receiving diuretic therapy;
12. End stage renal disease.

Exclusion Criteria for Control Cohort:

1. Pregnancy during period of observation or within 6 months of study entry;
2. Malignancy (other than squamous or basal cell carcinomas of the skin);
3. Newly diagnosed thyroid disorder within 6 months of study entry;
4. Long-term use of glucocorticoids (greater than 1 month of prednisone 5mg or higher or an equivalent dose of another glucocorticoid);
5. Use of androgenic steroids;
6. History of diabetes or use of glucose-lowering agents;
7. Use of the following psychiatric or anticonvulsant agents- thioridazine, olanzapine (zyprexa), clozapine (clozaril), quetiapine (seroquel), risperidone (risperdal), lithium, remeron, paxil, valproate, carbamazepine, gabapentin;
8. Treatment for hepatitis C infection during observation period;
9. Diagnosis of congestive heart failure and receiving diuretic therapy;
10. End stage renal disease.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
HIV-infected cohort	Drug: antiretroviral therapy; Standard of care antiretroviral therapy
HIV-uninfected control group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change in BMI from baseline after 12 months of initial antiretroviral therapy	12 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Change in the inflammatory marker, high-sensitivity C-reactive protein, from baseline after 12 months of antiretroviral therapy	12 Months
Change in the prothrombotic marker, D-dimer, from baseline after 12 months of initial antiretroviral therapy	12 Months

Collaborators and Investigators

• Sponsor: Duke University
• Collaborators: Janssen, LP
• Investigators: Principal Investigator: Wanda Lakey, MD, MHS, Duke University

Study record dates

Study Major Dates

• Study Start: November 1, 2009
• Primary Completion (ACTUAL): May 1, 2014
• Study Completion (ACTUAL): May 1, 2014

Study Registration Dates

• First Submitted: October 10, 2011
• First Submitted That Met QC Criteria: October 26, 2011
• First Posted (ESTIMATE): October 28, 2011

Study Record Updates

• Last Update Posted (ESTIMATE): October 14, 2015
• Last Update Submitted That Met QC Criteria: October 11, 2015
• Last Verified: May 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity; Anti-Infective Agents; Antiviral Agents; Anti-Retroviral Agents
• Other Study ID Numbers: Pro00020911