Weight gain after ART initiation associated with long-term cardiovascular, metabolic risks

Source/Disclosures

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Source:

Bares SH, et al. Clin Infect Dis. 2023;doi:10.1093/cid/ciad545.

Disclosures:
Bares reports receiving research grants to her institution from Janssen and ViiV Health Care, as well as scientific advisory to Gilead Sciences. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

• Weight gain after ART initiation is associated with long-term risks of cardiovascular and metabolic diseases.
• Patients who experienced a more than 10% weight gain had increased risks.

Weight gain and body composition changes that follow ART initiation are associated with long-term risks of cardiovascular and metabolic diseases, researchers reported.

“One of the common things we see after we start patients with newly diagnosed HIV on ART is weight gain, and although this is now a well-described phenomenon supported by a plethora of studies, the potential clinical complications of this weight gain is not as well understood,” Sara Hurtado Bares, MD, associate professor in the division of infectious diseases at the University of Nebraska Medical Center, told Healio.

“In fact, this initial weight gain is thought to be beneficial in some patients, particularly those who start treatment when their body mass index is in the normal or underweight categories, as it represents a return to health,” Bares said.

Because of this, Bares and colleagues wanted to gather more data to be able to contribute to discussions with patients when they initiate treatment.

“Should we discuss the risks of weight gain in patients who are not underweight at baseline when initiating antiretrovirals?” she said. “We sought to determine whether the initial weight gain that occurs after treatment initiation is associated with long-term risks of cardiovascular and metabolic disease to help inform these initial discussions as well as further research.”

To generate these data, the researchers fit linear regression models to assess the association between change in weight and/or waist circumference (WC) during weeks 0 to 48 and change in metabolic parameters during that same time frame, as well as weeks 48 to 96.

According to the study, they then used Cox proportional hazard models to examine the association between these changes in weight/WC in weeks 0 to 48 and diabetes mellitus (DM), metabolic syndrome or cardiometabolic and cardiovascular events after week 48.

In total, 2,624 patients were included in the study. Among these patients, 130 developed DM, 360 developed metabolic syndrome, 424 had a cardiometabolic event, 28 had any cardiovascular event and the average weight gain during weeks 0 to 48 was 3.6 kg. In adjusted models, the study also showed that total cholesterol increased by 0.63 mg/dL (95% CI, 0.38-0.89) and LDL by 0.39 mg/dL (95% CI, 0.19-0.59) per 1 kg increase in weight between weeks 0 and 48.

Additionally, the study revealed that participants who experienced a more than 10% weight gain had an increased risk of DM (HR = 2.01; 95% CI, 1.30, 3.08), metabolic syndrome (HR = 2.24; 95% CI, 1.55-2.62), and cardiometabolic outcomes (HR = 1.54; 95% CI, 1.22-1.95) compared with patients with a –5% to 5% weight increase, whereas patients who lost more than 5% of their baseline weight had a lower risk of incident metabolic syndrome (HR = 0.67; 95% CI, 0.42-1.07).

Based on these findings, Bares concluded that the initial weight gain that occurs after initiation of ART is associated with long-term risks of cardiovascular and metabolic disease.