During the first year after initiation of antiretroviral therapy (ART), changes in weight and body composition are associated with “contemporaneous changes in metabolic parameters and subsequent cardiometabolic disease,” researchers report. Among participants in the AIDS Clinical Trials Group (ACTG), short-term weight changes after ART initiation led to long-term cardiometabolic complications as the the cohort was followed for up to 10 years.
Based on statistical analysis of the association between changes in weight and weight circumference (WC) in weeks 0-48 and diabetes mellitus (DM), metabolic syndrome, or cardiometabolic and cardiovascular events after week 48, the authors found: “Participants (n = 2,624) were primarily male (81%) and non-White (60%). Mean weight gain from 0-48 weeks was 3.6 kg (SD 7.3); 130 participants developed DM; 360 metabolic syndrome; 424 any cardiometabolic event; 28 any cardiovascular event, over 480 weeks of follow-up. In adjusted models, total cholesterol increased by 0.63 mg/dL (95% CI 0.38, 089) and LDL by 0.39 mg/dL (0.19, 0.59) per 1 kg increase in weight from weeks 0-48. Participants who experienced >10% weight gain (vs -5% to 5%) had an increased risk of DM (HR 2.01, 95% CI [1.30, 3.08]), metabolic syndrome (HR 2.24 [1.55, 2.62]), and cardiometabolic outcomes (HR 1.54, 95% CI [1.22, 1.95]). Participants who lost more than 5% of their baseline weight had a lower risk of incident metabolic syndrome (HR 0.67 [0.42, 1.07]). Trends for WC were similar.”