Prevalence of overweight and obesity and associated factors among people living with HIV attending a tertiary care clinic in Uganda

A Meta-Analysis of Prevalence and Moderating Factors of Malnutrition Among People Living With HIV Across Countries

ABSTRACT

Malnutrition is a critical issue for people living with HIV (PLWH), affecting their immune function, health outcomes, and response to antiretroviral therapy. This meta-analysis assessed the prevalence of malnutrition among PLWH and explored key moderating factors across countries. A systematic search of six databases-Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest, PubMed, Scopus, and Web of Science, included 103 studies involving 240,879 PLWH. The pooled prevalence of malnutrition was 16.6% (95% confidence interval = 14.1-19.5). Subgroup analysis revealed higher prevalence in Southeast Asia (31.1%), PLWH with primary education (37.7%), those on antiretroviral therapy for over a year (51.7%), and World Health Organization Stage 3 (36.4%). Meta-regression identified alcohol consumption, smoking, hepatitis, and tuberculosis as significant moderators. The prevalence of malnutrition among PLWH is substantial, with several moderating factors identified. Addressing malnutrition among PLWH requires routine nutritional assessments and targeted interventions to improve health outcomes and quality of life for PLWH globally.

Factors influencing antiretroviral therapy switching in people with virologically suppressed HIV-1: a cross-sectional multicenter study in France

INTRODUCTION

In France, over 90% of people with HIV-1 (PWH) achieve virological suppression with effective combination of antiretroviral therapies (ART), but limited data exist on the motivation for switching ART.

OBJECTIVE

To describe the reasons and determinants for switching ART, with a particular focus on doravirine-based regimens, in routine clinical practice in France.

DESIGN

This analysis of cross-sectional baseline data is part of the DoraVIH study, a French, multicenter (15 sites), two-step observational cohort study that includes prospective follow-up for a subset of participants.

METHODS

Eligible participants were PWH under ART regimen, virologically suppressed for at least 6 months, doravirine-naive and switching ART regimen. Sociodemographic and clinical data, ART history and reasons for switching ART were assessed at baseline.

RESULTS

Inclusions occurred between 13 December 2021 and 21 September 2022. Of the 291 PWH included, whose data were analyzed, 143 switched to doravirine-based regimen (DOR PWH) and 148 to another combined regimen (non-DOR PWH). Mean age was 51.6 years, and 206 participants (70.8%) were men. At baseline, 35 (25.0%) DOR PWH and 15 (10.6%) non-DOR PWH had BMI at least 30 kg/m 2 ( P  = 0.007). The most common reasons for switching were treatment simplification, tolerability and drug-drug interactions, accounting for 79.7% of all reasons. Among the 68 participants with prior tolerability issues, 47 (69.1%) switched to doravirine-based regimen.

CONCLUSION

Primary reasons for switch were treatment simplification and tolerability. Participants with obesity were more likely to switch to doravirine, reflecting physicians' favorable perception of doravirine potential benefits, particularly in managing weight gain.

Overweight and Obesity Among People Living With HIV on Dolutegravir- and Efavirenz-Based Therapies: A Comparative Cross-Sectional Study

Background: Overweight and obesity have arisen as major public health challenges, affecting not just the general population but also people living with human immunodeficiency virus (HIV) (PLWH). Obesity and being overweight are both risk factors for heart disease and other related complications. However, little is known in our setting. As a result, this study was conducted to evaluate the prevalence of overweight and obesity and its associated factors among PLWH on dolutegravir (DTG)- and efavirenz (EFV)-based therapies. Methods: An institution-based comparative cross-sectional study was carried out from June 30, 2021, to August 30, 2021. We purposively recruited 128 participants who have been on DTG (n = 64)- and EFV (n = 64)-based regimens for ≥ 6 months. Demographic, anthropometric, laboratory, and clinical data were collected using a structured questionnaire. The data were entered into EpiData Version 4.6 and analyzed using SPSS Version 26.0. Multivariable logistic regression was utilized to identify the factors that are associated with being overweight or obese, and the significance level was set at p < 0.05. Result: The prevalence of overweight and obesity was 28.1% in the DTG-prescribed participants and 15.6% in the EFV-prescribed participants. Age ≥ 40 years (adjusted odd ratio (AOR) = 3.86; 95% confidence interval (CI): 1.08-13.73; and p=0.037), cluster of differentiation 4 (CD4) T-cell counts ≥ 500 cells/mm3 (AOR = 2.95; 95% CI: 1.01-8.59; and p=0.029), and insufficient physical activity (AOR = 4.6; 95% CI: 1.53-13.84; and p=0.007) were predictors of overweight and obesity. Conclusion: Overweight and obesity are not uncommon among PLWH on ART. While the difference was statistically insignificant, the prevalence of overweight and obesity was higher in patients treated with DTG compared with those treated with EFV. Older age, higher CD4 cell counts, and insufficient physical activity were associated with overweight and obesity. As a result, healthcare providers must understand the health implications of obesity and consider incorporating targeted weight control programs into standard HIV treatment.

Obesity Defining Criteria, and Association with Cardiovascular Disease Risk Factors Among People Living with HIV in Jos, Nigeria

Background

Obesity is linked to non-communicable conditions. We looked at obesity using four definable criteria and their relationship to biochemical and inflammatory indicators of cardiovascular diseases (CVDs) in people living with HIV (PLHIV).

Methodology

This cross-sectional study involved 140 randomly selected HIV-infected patients attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Anthropometric measurements such as height, weight, waist circumference, and hip circumference were taken to identify those with obesity. Fasting plasma glucose, lipid profile, High-sensitivity CRP (hsCRP), and HIV-related markers were evaluated.

Result

The mean (SD) age of the participants was 42.5 (8.8) years, and the majority (71.4%) were females. The prevalence of Obesity based on Body-Mass-Index (BMI), International Diabetes Federation (IDF), Adult Treatment Panel (ATP), and Waist-Hip-Ratio (WHR) criteria were 18.6%, 50.7% 34.3%, and 45.7% respectively. Obesity concordance among the criteria for obesity was highest between IDF and ATP (Kappa= 0.673, p<0.001); and least between BMI vs WHR (Kappa= 0.124, p<0.073). Only 9.3% had obesity by all 4 criteria. BMI was independently associated with hypertension but not glycaemic status nor dyslipidaemia while Obesity by WHR was significantly associated with hypertension and dyslipidaemia, after adjusting for age and sex. There was no significant association between Obesity by all the criteria and HIV-related parameters such as duration of HIV infection, Antiretroviral (ARV) use, and CD4 counts (p>0.05).

Conclusion

Our study urges a unified assessment of obesity and a more prominent use of parameters of central obesity, for assessing cardiovascular risk in PLHIV.

Epidemiology of obesity among people with HIV

PURPOSE OF REVIEW

People with HIV (PWH) on antiretroviral therapy (ART) globally are disproportionately affected by obesity, with prevalence rates highest among women with HIV. The purpose of this review is to discuss rates of obesity, factors associated with obesity, and adverse consequences of obesity among PWH.

RECENT FINDINGS

Among PWH on ART, rates of obesity have increased over the last several decades and tend to be higher than the general population. Weight gain with the initiation of new ART regimens such as integrase strand transfer inhibitor (INSTI)-based regimens are thought to contribute to higher rates of obesity among PWH on ART. Other factors, such as sex and ethnicity, also are associated with obesity among PWH on ART. Higher obesity rates among PWH may contribute to heightened cardiometabolic disease risk and lower health-related quality of life.

SUMMARY

Prospective studies which identify factors associated with increased obesity prevalence and weight gain among PWH are necessary for the development and implementation of obesity prevention and treatment strategies among PWH on ART and, in turn, reduce the prevalence of obesity in this population.

Metabolic Syndrome and Associated Factors Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy in Northern Tanzania

PURPOSE

Chronic systemic inflammation from human immunodeficiency virus (HIV) may cause metabolic abnormalities in lipid metabolism. Additionally, the development of metabolic syndrome has been associated with specific anti-retroviral therapy, particularly dolutegravir. This study aimed to determine the prevalence and associated factors of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.

METHODS

This was an analytical cross-sectional study conducted between October 1, 2022, and March 31, 2023, among 312 people living with HIV. A structured questionnaire was used to collect socio-demographic and clinical characteristics including anthropometric indices and a blood pressure reading. A blood sample was collected to measure plasma glucose levels and serum lipid levels. The outcome being metabolic syndrome, odds ratios were evaluated using logistic regression analysis, and a P-value of <.05 was considered statistically significant.

RESULTS

The prevalence of metabolic syndrome was 42.3%. Waist circumference (73%) and reduced high-density lipoprotein cholesterol (59.9%) were the most prevalent components. Factors associated with metabolic syndrome were patients aged 18-44 years (aOR: 3.10; 95% CI: 1.24-7.79; P = .016), female gender (aOR: 5.40; 95% CI: 2.07-14.13; P = .001), no physical activity (aOR: 4.00; 95% CI: 1.05-15.10; P = .042), and patients who earned >300 000 Tanzanian shillings per month (aOR: 2.15; 95% CI: 1.07-4.32; P = .032).

CONCLUSION

The prevalence of metabolic syndrome among patients on dolutegravir-based therapy is high. There is a need to adhere to routine screening of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.

"High blood pressure comes from thinking too much": Understandings of illness among couples living with cardiometabolic disorders and HIV in Malawi

Cardiometabolic disorders (CMD) such as hypertension and diabetes are increasingly prevalent in sub-Saharan Africa, placing people living with HIV at risk for cardiovascular disease and threatening the success of HIV care. Spouses are often the primary caregivers for people living with CMD, and understanding patients' and partners' conceptions of CMD could inform care. We conducted semi-structured interviews with 25 couples having a partner living with HIV and either hypertension or diabetes. Couples were recruited from HIV clinics in Malawi and were interviewed on beliefs around symptoms, causation, prevention, and treatment for CMD. Data were analyzed at the individual and dyadic levels using framework analysis and Kleinman's theory of explanatory models as a lens. On average, participants were 51 years old and married for 21 years. Approximately 57%, 14%, and 80% had hypertension, diabetes, and HIV. Couples endorsed a combination of biomedical explanatory models (beliefs around physical and mental health) and traditional explanatory models (beliefs around religion and natural remedies), although tended to emphasize the biomedical model. Half of couples believed stress was the main cause of hypertension. For diabetes, diet was believed to be a common cause. In terms of prevention, dietary changes and physical activity were most frequently mentioned. For disease management, medication adherence and diet modifications were emphasized, with some couples also supporting herbal remedies, stress reduction, and faith in God as strategies. Participants were generally more concerned about CMD than HIV due to poor access to CMD medications and beliefs that CMD could lead to sudden death. Within couples, partners often held many of the same beliefs but diverged around which etiological or preventive factors were most important (e.g., stress versus diet) and the best diet for CMD. Health education programs should involve primary partners to build knowledge of CMD and address overlap with HIV, and reinforce accurate information on lifestyle factors for the prevention and treatment of CMD.

Association Between Overweight/Obesity and ART Drug Regimen Among Adult HIV Patients in Gamo Zone Public Health Facilities Southern Ethiopia

Introduction

Overweight/obesity is an emerging public health problem in low income countries. Currently sub-Saharan African countries are facing a double burden of malnutrition. Evidence has shown that overweight/obesity is becoming a problem for people living with HIV. But little is known in our setting. Thus, this study is designed to assess the association between overweight/obesity and ART drug regimen among adult HIV patients in Gamo zone public health facilities southern Ethiopia.

Objective

To assess the association between overweight/obesity and ART drug regimen among adult HIV patients in Gamo zone public health facilities southern Ethiopia.

Methods

Institution-based cross-sectional study was conducted from April 10 to May 10, 2022, among systematically selected adult HIV patients. The data were collected by using a structured interviewer-administered questionnaire, patient record review, and physical measurements. Multivariate logistic regression model was used to assess the association between dependent and independent variables. A p-value <0.05 with its 95% CI was considered as a statistically significant and interpreted accordingly.

Results

The magnitude of overweight/obesity were 13.5% (95% CI:(10.4-17.2)). Being male (2.484(1.308, 4.716)), duration on ART (took for ≥5 years) ((2.249(1.218, 4.152)), and ART drug regime (3.789(1.965, 7.304)) were significantly associated with overweight/obesity.

Conclusion

Overweight/obesity is significantly associated to ART drug regimen type among adult HIV patients. Furthermore, sex and duration on ART drug were found significantly associated with overweight/obesity of adult HIV patients.

HIV and obesity: updates in management strategies

PURPOSE OF REVIEW

Weight gain has emerged as an important problem in people with HIV (PWH). When dealing with obesity, PWH face additional challenges to those without HIV. Understanding the nature of the problem and the modern evidence is essential to optimize management and identify knowledge gaps.

RECENT FINDINGS

Some PWH treated with antiretroviral therapy (ART) gain unhealthy amounts of weight and develop consequences of obesity. Newer agents have been consistently associated with excessive weight gain. Key studies are underway to inform the optimal use of specific ART in PWH dealing with obesity. For weight management, behavioral interventions fostering a healthier and active lifestyle, coupled with pharmacological therapies such as glucagon-like peptide 1 receptor agonists may be effective strategies in PWH, as recently demonstrated in those without HIV, although data in this regard is pending.

SUMMARY

A growing body of research has come to light in recent years regarding weight gain and obesity in PWH. However, much of the knowledge that inform current practices is extrapolated from studies in people without HIV. Modern ART regimens may promote excessive weight gain in some, and more research is needed to optimize ART selection and the use of weight loss medications.