Obesity is associated with the clustering
of multiple health problems in HIV-positive people, investigators from the US
report in the online edition of the Journal
of Acquired Immune Deficiency Syndromes. Compared to people of a healthy
weight, obese individuals were 50% more likely to have multiple health problems
such as metabolic disturbances and mood disorders.
“Obesity was associated with a
significantly higher likelihood of multimorbidity,” comment the investigators.
“The issue of weight management must be stressed in longitudinal care in order
to diminish its impact on multimorbidity among HIV-infected patients.”
The diseases of ageing are an increasingly
important cause of serious illness and death in people with HIV. An
increasing number of HIV-positive individuals are living with two or more
chronic health conditions in different disease areas. This clustering of
multiple health conditions is often called 'multimorbidity' and in the general
population has been shown to have serious long-term implications.
Another emerging health problem for
HIV-positive people in the US is obesity. Research conducted by at the HIV
clinic of the University of Alabama at Birmingham showed that 45% of
patients not yet taking antiretroviral therapy were overweight or obese.
Investigators at the clinic wanted to see
how many of their patients had multiple chronic diseases and if this was
associated with obesity.
They therefore reviewed the records of 1844
adult patients who received care between July 2010 and June 2011. All were
taking antiretroviral therapy.
Chronic diseases were clustered into three
- Metabolic – hypertension, gout,
diabetes mellitus, chronic kidney disease.
- Behavioural – mood disorders, high
lipids, chronic obstructive pulmonary disease, chronic ulcer disease,
arthritis, chronic sleep apnoea and cardiac disorders.
- Substance use – alcohol and
drug abuse, smoking and hepatitis C co-infection.
Participants were grouped into four weight
categories according to their BMI:
- Underweight – below 18.5 kg/m2.
- Normal weight – 18.5 to 24.9 kg/m2.
- Overweight – 25 to 29.9 kg/m2.
- Obese – 30 kg/m2 and
The investigators performed a series of
statistical analyses to see if obesity and certain other risk factor were
associated with the presence of diseases from more than one cluster.
Over three-quarters (77%) of participants were
men, their mean age was 44 years and 46% were white. Most people (71%) had a
CD4 cell count above 350 cells/mm3.
Almost two-thirds of participants were
overweight (36%) or obese (29%).
Overall, 65% of participants had chronic
diseases from two or more of the disease clusters. The prevalence of multiple
morbidity increased with each progressive BMI category: underweight, 56%;
normal weight, 62%; overweight, 67%; obese, 69%.
Compared to people with a healthy weight,
obese individuals were significantly more likely to develop a chronic condition from
two or more disease clusters (OR = 1.52; 95% CI, 1.15-2.00). “Conditions such
as obesity and dyslipidemia in particular, once considered to be a side-effect
of ART [antiretroviral therapy], are now observed as baseline condition for
treatment-naïve HIV-infected patients…and play a key role in multimorbidity,”
comment the authors.
Increasing age was also a risk factor for
the presence of multiple health problems (each ten-year increase, OR = 1.81;
95% CI, 1.62-2.02). “Increased longevity among well-managed HIV patients will
likely contribute to higher rates of multimorbidity in the future and will play
a key role in the evolving needs of our patients population,” suggest the investigators.
They conclude: “The impact of ageing,
obesity and increasing prevalence of multimorbidity in the HIV-infected
population will have far reaching implications…our attempt to characterize
multimorbidity patterns and observe commonly co-occurring conditions will
provide critical first steps in further defining the scope of the problem, and
inform interventions to address the management of multimorbidity in the context