Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis

Amit C Achhra; Caroline Sabin; Lene Ryom; Camilla Hatleberg; Monforte Antonella dʼAminio; Stephane de Wit; Andrew Phillips; Christian Pradier; Rainer Weber; Peter Reiss; Wafaa El-Sadr; Fabrice Bonnet; Amanda Mocroft; Jens Lundgren; Matthew G Law; D:A:D Study Group

doi:10.1097/QAI.0000000000001722

Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis

Amit C Achhra, Caroline Sabin, Lene Ryom, Camilla Hatleberg, Monforte Antonella dʼAminio, Stephane de Wit, Andrew Phillips, Christian Pradier, Rainer Weber, Peter Reiss, Wafaa El-Sadr, Fabrice Bonnet, Amanda Mocroft, Jens Lundgren, Matthew G Law, D:A:D Study Group

Department of Clinical Medicine

11 Citations (Scopus)

Abstract

Background: The relationship between body mass index (BMI) [weight (kg)/height (m 2)] and serious non-AIDS events is not well understood. Methods: We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m 2. Results: Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001). Conclusions: Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.

Original language	English
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	78
Issue number	5
Pages (from-to)	579-588
ISSN	1525-4135
DOIs	https://doi.org/10.1097/QAI.0000000000001722
Publication status	Published - 15 Aug 2018

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10.1097/QAI.0000000000001722

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Achhra, A. C., Sabin, C., Ryom, L., Hatleberg, C., Antonella dʼAminio, M., de Wit, S., Phillips, A., Pradier, C., Weber, R., Reiss, P., El-Sadr, W., Bonnet, F., Mocroft, A., Lundgren, J., Law, M. G., & D:A:D Study Group (2018). Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis. Journal of Acquired Immune Deficiency Syndromes, 78(5), 579-588. https://doi.org/10.1097/QAI.0000000000001722

Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis. / Achhra, Amit C; Sabin, Caroline; Ryom, Lene et al.
In: Journal of Acquired Immune Deficiency Syndromes, Vol. 78, No. 5, 15.08.2018, p. 579-588.

Research output: Contribution to journal › Journal article › Research › peer-review

Achhra, AC, Sabin, C, Ryom, L, Hatleberg, C, Antonella dʼAminio, M, de Wit, S, Phillips, A, Pradier, C, Weber, R, Reiss, P, El-Sadr, W, Bonnet, F, Mocroft, A, Lundgren, J, Law, MG & D:A:D Study Group 2018, 'Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis', Journal of Acquired Immune Deficiency Syndromes, vol. 78, no. 5, pp. 579-588. https://doi.org/10.1097/QAI.0000000000001722

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title = "Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis",

abstract = "Background: The relationship between body mass index (BMI) [weight (kg)/height (m 2)] and serious non-AIDS events is not well understood. Methods: We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m 2. Results: Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and {"}BMI-NADCs{"}: 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001). Conclusions: Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.",

author = "Achhra, {Amit C} and Caroline Sabin and Lene Ryom and Camilla Hatleberg and {Antonella dʼAminio}, Monforte and {de Wit}, Stephane and Andrew Phillips and Christian Pradier and Rainer Weber and Peter Reiss and Wafaa El-Sadr and Fabrice Bonnet and Amanda Mocroft and Jens Lundgren and Law, {Matthew G} and {D:A:D Study Group}",

year = "2018",

month = aug,

day = "15",

doi = "10.1097/QAI.0000000000001722",

language = "English",

volume = "78",

pages = "579--588",

journal = "Journal of Acquired Immune Deficiency Syndromes",

issn = "1525-4135",

publisher = "Lippincott Williams & Wilkins",

number = "5",

}

TY - JOUR

T1 - Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals

T2 - D: A: D Cohort Analysis

AU - Achhra, Amit C

AU - Sabin, Caroline

AU - Ryom, Lene

AU - Hatleberg, Camilla

AU - Antonella dʼAminio, Monforte

AU - de Wit, Stephane

AU - Phillips, Andrew

AU - Pradier, Christian

AU - Weber, Rainer

AU - Reiss, Peter

AU - El-Sadr, Wafaa

AU - Bonnet, Fabrice

AU - Mocroft, Amanda

AU - Lundgren, Jens

AU - Law, Matthew G

AU - D:A:D Study Group

PY - 2018/8/15

Y1 - 2018/8/15

N2 - Background: The relationship between body mass index (BMI) [weight (kg)/height (m 2)] and serious non-AIDS events is not well understood. Methods: We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m 2. Results: Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001). Conclusions: Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.

AB - Background: The relationship between body mass index (BMI) [weight (kg)/height (m 2)] and serious non-AIDS events is not well understood. Methods: We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m 2. Results: Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001). Conclusions: Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.

U2 - 10.1097/QAI.0000000000001722

DO - 10.1097/QAI.0000000000001722

M3 - Journal article

C2 - 29771788

SN - 1525-4135

VL - 78

SP - 579

EP - 588

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

IS - 5

ER -

Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis

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