Except in more extreme cases, cardiovascular disease risk does not increase when PLWH gain weight after starting antiretroviral therapy, a study published in the Journal of Acquired Immune Deficiency Syndromes found. Diabetes mellitus (DM) risk, however, increased significantly among people who experienced a weight gain of 10 kg or more upon ART initiation, independent of baseline BMI.
Data came from 43,805 participantsin the longitudinal D:A:D study—74% men, 51% white—who had at least one year of follow-up data available, including two or more separate BMI measurements. Overall, there were 2,104 CVD events for a rate of 5.8/1000 person-years. The corresponding diabetes rate was 4.5/1000 person-years.
Participants were stratified by baseline BMI. Few had a very high BMI (> 35 kg/m2), so the top group was a BMI of 30+ kg/m2. (CVD risk may only increase at very high BMIs, which might explain the current findings, study authors noted.)
BMI changes of < 2 kg/m2 (i.e., gaining < 10 kg of weight) did not change diabetes risk. Beyond that threshold, the more BMI increased, the greater the DM risk. Data predated the introduction of INSTIs, a class of drugs that has been associated with weight gain. Behavioral data on diet and exercise were not available.
There was some indication for a higher CVD risk among those starting out with a very low BMI (< 20 kg/m2) who lost weight after beginning ART. Since weight measurements lagged CVD and diabetes events by 12 months, poor health is unlikely to be the explanation for this finding, the study authors posited. Instead, they suggested, people with low weight may not have been considered at risk for CVD—and as a result, they may not have been counseled on prevention to the degree that heavier-set people would have been.
There were too few women or Black people—two groups in which BMI response to INSTIs has been shown to differ from white men—to analyze data by these demographic characteristics. Study authors called for large cohort studies that include more women and also investigate the effect of INSTI exposure on CVD risk.