NIAID Now | August 23, 2019
Dramatic improvements in antiretroviral therapy (ART) have enabled people living with HIV to live near-normal lifespans. As a result, noninfectious chronic diseases are becoming greater concerns for people with HIV, and for their healthcare providers. Gaining weight around the waistline (abdominal or belly fat) is a common problem for people living with HIV. This weight gain is a health concern because obesity—and abdominal fat in particular—is a risk factor for heart disease and other chronic health problems such as diabetes.
ART for HIV/AIDS has been associated with harmful weight gain. The effects of ART on abdominal fat gain appear to be more important in women and black people, and some ART regimens may be more associated with weight gain than others.
To learn more about the risk factors for abdominal weight gain in people infected with HIV and on ART, researchers analyzed data from a NIAID-funded AIDS Clinical Trial Group study. The study was designed to compare the effectiveness of three different ART regimens in 1,809 people with HIV who had not previously been treated with anti-HIV drugs. The researchers used two methods to assess abdominal weight gain: waist measurements and self-reported changes in belly size from a questionnaire on body image. Measuring waist circumference is an inexpensive and simple way to evaluate abdominal fat accumulation that has been shown to correlate well with more costly and labor-intensive imaging methods such as CT scans.
The team compared waist measurements and self-reported changes in belly size from the time just before study participants started ART and at 96 weeks after starting treatment. They found that increases in abdominal fat seen with certain types of ART were more pronounced in female and black study participants. Individuals who had more advanced HIV disease before starting treatment were also more likely to gain abdominal fat after starting on ART, suggesting another potential benefit of early initiation of ART.
These results provide new insights into factors that predispose individuals with HIV to abdominal fat gain. Understanding these factors may allow health providers to determine treatment approaches better suited to preventing such weight gain.
Reference: Bhagwat P et al. Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen: effects of sex and race. Open Forum Infectious Diseases. 2018 Nov 16;5(11):ofy201.