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Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A:D study
- Source :
- HIV Medicine. 17:255-268
- Publication Year :
- 2015
- Publisher :
- Wiley, 2015.
-
Abstract
- Objectives The aim of the study was to assess the impact of the gain in body mass index (BMI) observed immediately after antiretroviral therapy (ART) initiation on the subsequent risk of cardiovascular disease (CVD) and diabetes. Methods We analysed data from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort study. Outcomes were development of (i) CVD (composite of myocardial infarction/stroke/coronary procedure) and (ii) diabetes. The main exposure variable was change in BMI from ART initiation (pre-ART) to 1 year after initiation (continuous variable) in treatment-naive individuals initiating ART with no history of CVD or diabetes (for respective outcomes). BMI [weight (kg)/(height (m))2] was categorized as underweight ( 30). Poisson regression models were fitted stratified for each pre-ART BMI category to allow for category-specific estimates of incidence rate ratio (IRR). Models were adjusted for pre-ART BMI and CD4 count, key known risk factors (time-updated where possible) and calendar year. Results A total of 97 CVD events occurred in 43 982 person-years (n = 9321) and 125 diabetes events in 43 278 person-years (n = 9193). In fully adjusted analyses for CVD, the IRR/unit gain in BMI (95% confidence interval) in the first year of ART, by pre-ART BMI category, was: underweight, 0.90 (0.60–1.37); normal, 1.18 (1.05–1.33); overweight, 0.87 (0.70–1.10), and obese, 0.95 (0.71–1.28) (P for interaction = 0.04). For diabetes, the IRR/unit gain in BMI was 1.11 (95% confidence interval 1.03 to 1.21), regardless of pre-ART BMI (P for interaction > 0.05). Conclusions Short-term gain in BMI following ART initiation appeared to increase the longer term risk of CVD, but only in those with pre-ART BMI in the normal range. It was also associated with increased risk of diabetes regardless of pre-ART BMI.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Overweight
Rate ratio
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
Medicine
Pharmacology (medical)
030212 general & internal medicine
2. Zero hunger
business.industry
Health Policy
medicine.disease
030112 virology
Confidence interval
3. Good health
Infectious Diseases
Physical therapy
medicine.symptom
Underweight
business
Weight gain
Body mass index
Cohort study
Subjects
Details
- ISSN :
- 14642662
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- HIV Medicine
- Accession number :
- edsair.doi...........bd997f713ce0d21eab86494987d7ceec