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Background:  Obesity and HIV infection are ongoing epidemics in the United States. Obesity predisposes to diabetes and cardiovascular disease, which are complications also associated with HIV infection or its treatment. We characterized the prevalence and risk factors of overweight and obesity within a large urban cohort of HIV-infected individuals.

Methods:  Retrospective cross-sectional study of the 1678 patients enrolled in the University of Pennsylvania Center for AIDS Research Clinical Core Cohort Registry. Demographic, social, and medical data on these patients have been collected prospectively since 1999. The usual body mass index definitions of overweight (body mass index between 25 and 29.9 kg/m²) and obesity (>30 kg/m²) were used. Wasting was defined as a body mass index <20 kg/m².

Results:  Data were available for 1654 (98.6%) subjects. They were 78% men, 60% African American, 46% current smokers, 18% with prior IV drug abuse, 67% with income <₂5,000). The median CD4 was 377 cells/µL (IQR 220 to 581); 52% had a viral load <400 copies/mL; 9% of the patients were treatment naïve. Overweight and obesity were much more common than wasting, 31%, 14%, and 9% prevalence, respectively. While women and men were equally likely to be overweight (30% vs 31%, p = 0.655), women were significantly more likely than men to be obese (29% vs 11%, p <0.001). African Americans were more likely to be overweight or obese than non-African Americans (49% vs 42%, p = 0.012). Current CD4 >200 (RR 2.0, 1.5 to 2.6) was associated with being overweight or obese. Current smoking was protective (RR 0.6, 0.5 to 0.7). In a logistic regression model, female sex (RR 2.0, 1.5 to 2.7), African American race (RR 1.3, 1.0 to 1.6), smoking (RR 0.6; 0.5 to 0.8), and current CD4 (for each 100 cells/µL increment, RR 1.11, 1.06 to 1.16) were independent predictors of obesity. Age, income, employment, education, past or current IDU, being on HIV treatment and viral load were not associated with obesity.

Conclusions:  Obesity is a much more common problem than wasting in the current therapeutic era. While the combined 45% prevalence of overweight and obesity within our population is less than the overall 60% population prevalence for the state of Pennsylvania, it is nonetheless of epidemic proportion. Women, particularly those of color are at high risk. Baseline or acquired obesity might be a significant contributor to the metabolic abnormalities associated with HIV or its treatment. As patients with HIV live longer, obesity-related complications may contribute to morbidity. Specific dietary and lifestyle modifications to counter this will be needed in this population.

Keywords: Obesity; Overweight; African American women