Factors associated with obesity in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) cohort: an observational cross-sectional analysis

S Savinelli, D De Francesco, E R Feeney, D Babalis, E Bagkeris, F A Post, M Boffito, I Williams, J Vera, M Johnson, J Anderson, M Sachikonye, A Winston, C Sabin, Pwg Mallon, S Savinelli, D De Francesco, E R Feeney, D Babalis, E Bagkeris, F A Post, M Boffito, I Williams, J Vera, M Johnson, J Anderson, M Sachikonye, A Winston, C Sabin, Pwg Mallon

Abstract

Objectives: The aims of the study were to describe the prevalence of obesity in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) cohort, to identify demographic, clinical and HIV-specific factors associated with obesity, and to characterize the association between obesity and sociodemographic, clinical and HIV-specific factors and quality of life (QoL).

Methods: A cross-sectional analysis was carried out of baseline data from the three groups ["older" people with HIV infection (PWH) aged ≥ 50 years, "younger" PWH aged < 50 years and HIV-negative controls aged ≥ 50 years] within the POPPY cohort. Obesity was defined as a body mass index (BMI) > 30 kg/m2 .

Results: A total of 1361 subjects were included in the study, of whom 335 (24.6%) were obese. The prevalence of obesity was higher in controls (22.3%) than in older (16.8%) and younger (14.2%) PWH, with no differences between the two groups of PWH. Factors associated with obesity were older age, female gender, black African ethnicity and alcohol consumption. Recreational drug use and a higher current CD4 T-cell count (in PWH) were associated with lower and higher odds of being obese, respectively. The presence of obesity was associated with worse physical health QoL scores, higher odds of having cardiovascular disease, type 2 diabetes and hypertension, but lower odds of having osteopenia/osteoporosis, irrespective of HIV status.

Conclusions: Despite a lower prevalence of obesity in PWH, specific subgroups (women, people of black African origin and older people) were more likely to be obese, and negative health consequences of obesity were evident, regardless of HIV status. Whether targeted preventive strategies can reduce the burden of obesity and its complications in PWH remains to be determined.

Keywords: HIV; comorbidities; obesity; prevalence; risk factors.

© 2020 British HIV Association.

References

    1. World Health Organisation. Obesity and Overweight. Geneva, Switzerland: World Health Organisation; 2018 [updated February 2018; cited 2019 May 16]. Available from:
    1. Ponce-Garcia I, Simarro-Rueda M, Carbayo-Herencia JA et al. Prognostic value of obesity on both overall mortality and cardiovascular disease in the general population. PLoS ONE. 2015; 10 (5): e0127369.
    1. Samji H, Cescon A, Hogg RS et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013; 8 (12): e81355.
    1. Smith CJ, Ryom L, Weber R et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014; 384 (9939): 241-248.
    1. Koethe JR, Jenkins CA, Lau B et al. Rising obesity prevalence and weight gain among adults starting antiretroviral therapy in the United States and Canada. AIDS Res Hum Retroviruses. 2016; 32 (1): 50-58.
    1. Ilozue C, Howe B, Shaw S et al. Obesity in the HIV-infected population in Northeast England: a particular issue in Black-African women. Int J STD AIDS. 2017; 28 (3): 284-289.
    1. Bakal DR, Coelho LE, Luz PM et al. Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors. J Antimicrob Chemother. 2018; 73 (8): 2177-2185.
    1. Gelpi M, Afzal S, Lundgren J et al. Higher risk of abdominal obesity, elevated low-density lipoprotein cholesterol, and hypertriglyceridemia, but not of hypertension, in people living with human immunodeficiency virus (HIV): results from the copenhagen comorbidity in HIV infection study. Clin Infect Dis. 2018; 67 (4): 579-586.
    1. Ezechi LO, Musa ZA, Otobo VO, Idigbe IE, Ezechi OC. Trends and risk factors for obesity among HIV positive Nigerians on antiretroviral therapy. Ceylon Med J. 2016; 61 (2): 56-62.
    1. Semu H, Zack RM, Liu E et al. Prevalence and risk factors for overweight and obesity among HIV-infected adults in Dar es Salaam, Tanzania. J Int Assoc Provid AIDS Care. 2016; 15 (6): 512-521.
    1. Bloomfield GS, Hogan JW, Keter A et al. Hypertension and obesity as cardiovascular risk factors among HIV seropositive patients in Western Kenya. PLoS ONE. 2011; 6 (7): e22288.
    1. Huis in ’t Veld Diana, Pengpid Supa, Colebunders Robert, Peltzer Karl. Body mass index and waist circumference in patients with HIV in South Africa and associated socio-demographic, health related and psychosocial factors. AIDS Behav. 2018; 22 (6): 1972-1986.
    1. Guehi C, Badjé A, Gabillard D et al. High prevalence of being Overweight and Obese HIV-infected persons, before and after 24 months on early ART in the ANRS 12136 Temprano Trial. AIDS Res Ther. 2016; 25 (13): 12.
    1. Freitas P, Carvalho D, Santos AC et al. Prevalence of obesity and its relationship to clinical lipodystrophy in HIV-infected adults on anti-retroviral therapy. J Endocrinol Invest. 2012; 35 (11): 964-970.
    1. Santiprabhob J, Tanchaweng S, Maturapat S et al. Metabolic disorders in HIV-infected adolescents receiving protease inhibitors. Biomed Res Int. 2017; 2017: 7481597.
    1. Obry-Roguet V, Brégigeon S, Cano CE et al. Risk factors associated with overweight and obesity in HIV-infected people: aging, behavioral factors but not cART in a cross-sectional study. Medicine (Baltimore). 2018; 97 (23): e10956.
    1. Achhra AC, Mocroft A, Reiss P et al. Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A: D study. HIV Med. 2016; 17 (4): 255-268.
    1. Bagkeris E, Burgess L, Mallon PW et al. Cohort profile: The Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. Int J Epidemiol. 2018; 47 (5): 1391-1392e.
    1. Guaraldi G, Orlando G, Zona S et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011; 53 (11): 1120-1126.
    1. De Francesco D, Underwood J, Bagkeris E et al. Risk factors and impact of patterns of co-occurring comorbidities in people living with HIV. AIDS 2019; 33 (12): 1871-1880.
    1. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30 (6): 473-483.
    1. The UK Collaborative HIV Cohort Study website. Available at: [Accessed 19th July 2019].
    1. McGettrick P, Ghavami-Kia B, Tinago W et al. The HIV care cascade and sub-analysis of those linked to but not retained in care: the experience from a tertiary HIV referral service in Dublin Ireland. HIV Clin Trials. 2017; 18 (3): 93-99.
    1. Crum-Cianflone N, Tejidor R, Medina S, Barahona I, Ganesan A. Obesity among patients with HIV: the latest epidemic. AIDS Patient Care STDS. 2008; 22 (12): 925-930.
    1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016; 315 (21): 2284-2291.
    1. Ford ND, Patel SA, Narayan KM. Obesity in low- and middle-income countries: burden, drivers, and emerging challenges. Annu Rev Public Health. 2017; 20 (38): 145-164.
    1. Wang Y, Beydoun MA. The obesity epidemic in the United States-gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007; 29: 6-28.
    1. Wang L, Southerland J, Wang K et al. Ethnic differences in risk factors for obesity among adults in California, the United States. J Obes. 2017; 2017: 2427483.
    1. Venter WDF, Moorhouse M, Sokhela S et al. Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV. N Engl J Med. 2019; 381 (9): 803-815.
    1. Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev. 2012; 13 (11): 1067-1079.
    1. Mata J, Frank R, Hertwig R. Higher body mass index, less exercise, but healthier eating in married adults: Nine representative surveys across Europe. Soc Sci Med. 2015; 138: 119-127.
    1. Gallus S, Odone A, Lugo A et al. Overweight and obesity prevalence and determinants in Italy: an update to 2010. Eur J Nutr. 2013; 52 (2): 677-685.
    1. Brown A, Siahpush M. Risk factors for overweight and obesity: results from the 2001 National Health Survey. Public Health. 2007; 121 (8): 603-613.
    1. Newlin Lew K, Dorsen C, Long T. Prevalence of obesity, prediabetes, and diabetes in sexual minority men: results from the 2014 behavioral risk factor surveillance system. Diabetes Educ. 2018; 44 (1): 83-93.
    1. Sneve M, Jorde R. Cross-sectional study on the relationship between body mass index and smoking, and longitudinal changes in body mass index in relation to change in smoking status: the Tromso Study. Scand J Public Health. 2008; 36 (4): 397-407.
    1. Tian J, Venn A, Otahal P, Gall S. The association between quitting smoking and weight gain: a systematic review and meta-analysis of prospective cohort studies. Obes Rev. 2015; 16 (10): 883-901.
    1. Pengpid S, Peltzer K. Associations between behavioural risk factors and overweight and obesity among adults in population-based samples from 31 countries. Obes Res Clin Pract. 2017; 11 (2): 158-166.
    1. Hu L, Matthews A, Shmueli-Blumberg D, Killeen TK, Tai B, VanVeldhuisen P. Prevalence of obesity for opioid- and stimulant-dependent participants in substance use treatment clinical trials. Drug Alcohol Depend. 2018; 1 (190): 255-262.
    1. Lazo M, Nwankwo C, Daya NR et al. Confluence of Epidemics of Hepatitis C, Diabetes, Obesity, and Chronic Kidney Disease in the United States Population. Clin Gastroenterol Hepatol. 2017; 15 (12): 1957-1964.e7.
    1. Klop B, Elte JW, Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients. 2013; 5 (4): 1218-1240.
    1. Savas M, Muka T, Wester VL et al. Associations between systemic and local corticosteroid use with metabolic syndrome and body mass index. J Clin Endocrinol Metab. 2017; 102 (10): 3765-3774.
    1. Avila C, Holloway AC, Hahn MK et al. An overview of links between obesity and mental health. Curr Obes Rep. 2015; 4 (3): 303-310.
    1. Freiberg MS, Chang CC, Kuller LH et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013; 173 (8): 614-622.
    1. Hernandez-Romieu AC, Garg S, Rosenberg ES, Thompson-Paul AM, Skarbinski J. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010. BMJ Open Diabetes Res Care. 2017; 5 (1): e000304.
    1. Whiteside YO, Selik R, An Q et al. Comparison of rates of death having any death-certificate mention of heart, kidney, or liver disease among persons diagnosed with hiv infection with those in the general US population, 2009-2011. Open AIDS J. 2015; 27 (9): 14-22.
    1. Kooij KW, Vogt L, Wit FWNM et al. Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls. J Infect Dis. 2017; 216 (6): 622-631.
    1. Dolan E, Swinton PA, Sale C, Healy A, O'Reilly J. Influence of adipose tissue mass on bone mass in an overweight or obese population: systematic review and meta-analysis. Nutr Rev. 2017; 75 (10): 858-870.
    1. Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017; 7 (5): 273-289.
    1. Sabin CA, Harding R, Bagkeris E et al. Pain in people living with HIV and its association with healthcare resource use, well being and functional status. AIDS. 2018; 32 (18): 2697-2706.
    1. Mallon PW, Miller J, Cooper DA, Carr A. Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1-infected men starting therapy. AIDS. 2003; 17 (7): 971-979.
    1. Sax PE, Erlandson KM, Lake JE et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis. 2019; ciz999.
    1. McCann K, Moorhouse M, Sokhela Set al.The ADVANCE clinical trial: changes from baseline to week 96 in DXA-assessed body composition in TAF/FTC+DTG compared to TDF/FTC+DTG, and TDF/FTC/EFV. 17th European AIDS Conference. Basel, Switzerland, November 2019.
    1. Verboeket S, Boyd A, Wit Fet al.Switching to an integrase inhibitor containing antiretroviral regimen is not associated with above-average weight gain in middle-aged people living with HIV on long-term suppressive antiretroviral therapy, the AGEhIV cohort study. 17th European AIDS Conference. Basel, Switzerland, November 2019.

Source: PubMed

3
Tilaa