928 Overweight and HIV Progression in Women: Associations between HIV Disease Progression and Changes in Body Mass Index in the HIV Epidemiology Research Study Cohort C. Jones*1, J. Hogan2, B. Snyder2, R. Klein3,4, A. Rompalo5, P. Schuman6, C. Carpenter7 1Tufts Univ Sch of Med, Boston, MA; 2Brown Univ, Providence, RI; 3Montefiore Med Ctr, Bronx, NY; 4Albert Einstein Sch of Med, Bronx, NY; 5Johns Hopkins Univ Sch of Med, Baltimore, MD; 6Wayne State Univ Sch of Med, Detroit, MI; and 7Brown Med Sch, Providence, RI
Background: Adverse effects of overweight/obesity are well known. However, several studies have reported an association of increased weight with improved survival or slower HIV progression in HIV-infected persons. These studies did not include large numbers of women. Women are at higher risk for overweight/obesity; thus it is important to assess whether this association is seen in HIV-infected women.
Methods: A total 871 HIV infected women were enrolled in the HIV Epidemiology Research Study (HERS) and followed at baseline and 6-month intervals with interviews, blood work, and physical examination. BMI was calculated from height and weight measures. Multiple indicators of HIV progression (time to first CD4 < 200, first CD4 < 100, opportunistic infection and HIV-related death) were analyzed. Effect of baseline BMI weight group on times to event was evaluated using the logrank test, and multivariate regression models were used to adjust for baseline covariates. The effect of within-individual changes in BMI on rate of progression was characterized using logistic regression for discrete event times with time-varying BMI as the primary independent variable. Association between change in BMI and concurrent change in CD4 was estimated using repeated measures regression modeling. Regression models also adjusted for important baseline and time-varying covariates, including CD4 count, viral load, known duration of infection, risk cohort, time in study, baseline depression, and study site.
Results: Greater BMI at baseline is associated with a lower rate of first CD4 < 200, adjusted for covariates. Analyses incorporating time-varying BMI measurements show that compared with the highest BMI category (obese), those in lower categories (underweight, normal weight, and overweight) have increased risk of first CD4 < 200, CD4 <100, clinical AIDS and HIV-related death, adjusted for covariates. This difference was significant for clinical AIDS (underweight and normal weight vs obese), and for HIV-related death (underweight vs obese). Increases in BMI are positively associated with rate of change in CD4, even after controlling for prior values of CD4, viral load, and treatment status.
Conclusion: Higher BMI and increases in BMI are associated with decreased risk of HIV progression and with decreased CD4 decline in HIV-infected women.
