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      Higher Time-updated Body Mass Index: Association with Improved CD4+ Cell Recovery on HIV Treatment

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          Abstract

          Background

          Prior studies found overweight or obese HIV-infected individuals had greater early CD4+ cell recovery on antiretroviral therapy (ART), but the results have been inconsistent. We assessed the longitudinal relationship between body mass index (BMI) and CD4+ cell recovery on ART in a large, multi-site cohort to identify potential physiologic links between adiposity and CD4+ cell expansion.

          Methods

          We modeled the relationship of time-updated BMI with CD4+ count in patients starting ART from 17 North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) cohorts. The primary analysis used a linear mixed effects model incorporating up to 13 years of data per patient and adjusted for age, sex, race, ART regimen, baseline CD4+ count and other covariates. Sensitivity analyses limited the cohort to patients with sustained viral suppression or censored at virologic failure.

          Results

          14,084 HIV-infected individuals initiating ART contributed data between 1998 and 2010. Time-updated BMI was significantly associated with CD4+ cell recovery over time (p<0.001). After 5 years of ART, the mean CD4+ count at a BMI of 30 kg/m 2 was 22% higher than at a BMI of 22 kg/m 2 (606 vs. 498 cells/µL), and 34% higher at a BMI of 40 kg/m 2 (665 vs. 498 cells/µL). Results were similar in the sensitivity analyses.

          Discussion

          Higher BMI is associated with long-term advantages in immune recovery on ART. While it is unclear if this impacts health outcomes, including balancing the negative health effects of obesity, elucidating the underlying mechanism could identify therapies for patients with suboptimal immune reconstitution.

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          Author and article information

          Journal
          100892005
          21821
          J Acquir Immune Defic Syndr
          J. Acquir. Immune Defic. Syndr.
          Journal of acquired immune deficiency syndromes (1999)
          1525-4135
          1944-7884
          15 April 2016
          1 October 2016
          01 October 2017
          : 73
          : 2
          : 197-204
          Affiliations
          [1 ]Vanderbilt University School of Medicine, Nashville, Tennessee
          [2 ]Johns Hopkins University, Baltimore, Maryland
          [3 ]Kaiser Permanente Northern California, Oakland CA
          [4 ]Alberta HIV Clinic, Sheldon M Chumir Health Centre, Calgary, Canada
          [5 ]Universidad Central del Caribe, Bayamon, Puerto Rico
          [6 ]University of Alabama at Birmingham, Birmingham, Alabama
          [7 ]Harvard School of Public Health, Boston, MA
          [8 ]Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD
          [9 ]Yale University School of Medicine, New Haven and Veterans Affairs (VA) Connecticut Healthcare System, West Haven
          Author notes
          Corresponding author (same address for requests for reprints): John R. Koethe MD, MS, Division of Infectious Diseases, Vanderbilt University Medical Center, A2200-MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, john.r.koethe@ 123456vanderbilt.edu , office : 615-322-2035, fax : 615-343-6160
          Article
          PMC5023455 PMC5023455 5023455 nihpa777814
          10.1097/QAI.0000000000001035
          5023455
          27116044
          Categories
          Article

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