Changes in Waist Circumference in HIV-Infected Individuals Initiating a Raltegravir or Protease Inhibitor Regimen: Effects of Sex and Race.

• Type of Material: Article
• Authors: Priya Bhagwat, University of California, Los Angeles; Igho Ofotokun, Emory University; Grace A. McComsey, Case Western University; Todd T. Brown, Johns Hopkins University; Carlee Moser, Harvard T. H. Chan School of Public Health; Catherine A. Sugar, University of California, Los Angeles; Judith S. Currier, University of California, Los Angeles
• Language: English
• Date: 2018-11
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://academic.oup.com/ofid/article/5/11/ofy201/5185211
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 5
• Issue: 11
• Start Page: ofy201
• End Page: ofy201
• Grant/Funding Information: Dr. Sugar’s research is supported in part by the UCLA Center for AIDS Research (2P30 A1 028697-24-R2).; Dr. Moser served as a consultant for Northwestern University Infectious Diseases, and her research is supported in part by NIH/NIAID UM1 AI068634 and NIH/NHLBI R01 HL095132.; The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Preparation of this manuscript was supported by the Postdoctoral HIV Research Training Program for HIV Combination Prevention (T32MH109205).; Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (grant numbers UM1 AI068634, UM1 AI068636, and UM1 AI106701).
• Keywords: waist circumference; abdominal fat; metabolic complications; lipodystrophy; central adiposity
• Research Categories: Health Sciences, Public Health

Abstract

Background: This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods: We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results: The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions: With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.