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ObjectiveExamine changes in, and factors associated with changing body mass index (BMI) in women following highly active antiretroviral therapy (HAART) initiation.Methods1177 HIV-infected Women's Interagency HIV Study participants who contributed 10,754 years of follow-up following HAART initiation were studied. Changes in median BMI up to 15 years following HAART initiation, and the highest and lowest BMI reached following HAART initiation were summarized by pre-HAART BMI category (

BackgroundData regarding the association between HIV and diabetes mellitus (DM) are conflicting, with little known regarding the impact of including hemoglobin A1C (A1C) as a criterion for DM.MethodsPooled logistic regression was used to quantify the association between HIV and DM in 1501 HIV-infected and 550 HIV-uninfected participants from the Women's Interagency HIV Study. Incident DM was defined using the following 3 criteria, definition I: fasting glucose (FG) ≥126 mg/dL, anti-DM medication or reporting DM diagnosis (with confirmation by FG ≥126 mg/dL or anti-DM medication); definition II: confirmation with a second FG ≥126 mg/dL, and definition III: addition of A1C ≥6.5% confirmed by FG ≥126 mg/dL or anti-DM medication.ResultsDM incidence per 100 person-years was 2.44, 1.55, and 1.70 for HIV-infected women; 1.89, 0.85, and 1.13 for HIV-uninfected women, using definition I, II, and III, respectively. After adjustment for traditional DM risk factors, HIV infection was associated with 1.23-, 1.90-, and 1.38-fold higher risk of incident DM, respectively; the association reached statistical significance only when confirmation with a second FG ≥126 mg/dL was required. Older age, obesity, and a family history of DM were each consistently and strongly associated with increased DM risk.ConclusionsHIV infection is consistently associated with greater risk of DM. Inclusion of an elevated A1C to define DM increases the accuracy of the diagnosis and only slightly attenuates the magnitude of the association otherwise observed between HIV and DM. By contrast, a DM diagnosis made without any confirmatory criteria for FG ≥126 mg/dL overestimates the incidence, while also underestimating the effects of HIV on DM risk, and should be avoided.

The changes in regional anthropometry associated with stavudine exposure and discontinuation are examined in HIV-infected women. The HIV-infected women have shown reduction in weight and body circumference measurements, regardless of continuing or discontinuing stavudine and the lower limb is most affected by stavudine exposure, with stabilization observed more than 2 years after discontinuation.

Objective. We assessed the association of cigarette smoking with the effectiveness of highly active antiretroviral therapy (HAART) among low-income women. Methods. Data were analyzed from the Women's Interagency HIV Study, a multisite longitudinal study up to 7.9 years for 924 women representing 72% of all women who initiated HAART between July 1, 1995, and September 30, 2003. Results. When Cox's regression was used after control for age, race, hepatitis C infection, illicit drug use, previous antiretroviral therapy, and previous AIDS, smokers on HAART had poorer viral responses (hazard ratio [HR]=0.79; 95% confidence interval [CI] =0.67, 0.93) and poorer immunologic response (HR = 0.85; 95% CI = 0.73, 0.99). A greater risk of virologic rebound (HR = 1.39; 95% CI = 1.06, 1.69) and more frequent immunologic failure (HR = 1.52; 95% CI = 1.18, 1.96) were also observed among smokers. There was a higher risk of death (HR = 1.53; 95% CI = 1.08, 2.19) and a higher risk of developing AIDS (HR = 1.36; 95% CI = 1.07, 1.72) but no significant difference between smokers and nonsmokers in the risk of death due to AIDS. Conclusions. Some of the benefits provided by HAART are negated in cigarette smokers. doi:10.2105/AJPH.2005.062745)

The prevalence of specific protease inhibitor (PI) and nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations is described along with the relationship between the presence of these mutations and immunologic outcomes following PI/NNRTI initiation among a cohort of HIV-1--infected women. The results proved virologic failure associated with PI or NNRTI, as preserved CD4(super +) T-cell count responses was noticed alongside viremia with these resistance mutations.

A study aims to determine the association of race with clinical and laboratory outcomes after initiation of highly active antiretroviral therapy (HAART) in HIV-1-infected women in the US. The results reveal that no significant differences by race are found in virologic, immunologic, or clinical outcomes after adjustment for continued HAART use and depression.

The factors and temporal trends associated with discontinuation of highly active antiretroviral therapy (HAART) among 936 HIV-infected women enrolled in the Women's Interagency HIV Study are characterized. A multivariate analysis of post-HAART initiation exposures found that high HIV RNA levels and high depressive symptom scores were associated with HAART discontinuation.

Abstract Background Recombination between strains of HIV-1 only occurs in individuals with multiple infections, and the incidence of recombinant forms implies that multiple infection is common. Most direct studies indicate that multiple infection is rare. We determined the rate of multiple infection in a longitudinal study of 58 HIV-1 positive participants from The Women's Interagency HIV Study with a richer sampling design than previous direct studies, and we investigated the role of recombination and sampling design on estimating the multiple infection rate. Results 40% of our sample had multiple HIV-1 infections. This rate of multiple infection is statistically consistent with previous studies once differences in sampling design are taken into account. Injection drug use significantly increased the incidence of multiple infections. In general there was rapid elimination of secondary strains to undetectable levels, but in 3 cases a superinfecting strain displaced the initial infecting strain and in two cases the strains coexisted throughout the study. All but one secondary strain was detected as an inter- and/or intra-genic recombinant. Injection drug use significantly increased the rate of observed recombinants. Conclusion Our multiple infection rate is consistent with rates estimated from the frequency of recombinant forms of HIV-1. The fact that our results are also consistent with previous direct studies that had reported a much lower rate illustrates the critical role of sampling design in estimating this rate. Multiple infection and recombination significantly add to the genetic diversity of HIV-1 and its evolutionary potential, and injection drug use significantly increases both.

Determines the association of race with clinical and laboratory outcomes following initiation of highly active antiretroviral therapy in HIV-1-infected women in the U.S. Efficacy of antiretroviral therapies; Differences in behavior or in biologically determined pathways of drug metabolism and transport; Challenges in investigating racial and ethnic differences in biomedical processes.