Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors

J Antimicrob Chemother. 2018 Aug 1;73(8):2177-2185. doi: 10.1093/jac/dky145.


Background: Obesity rates are increasing among HIV-infected individuals, but risk factors for obesity development on ART remain unclear.

Objectives: In a cohort of HIV-infected adults in Rio de Janeiro, Brazil, we aimed to determine obesity rates before and after ART initiation and to analyse risk factors for obesity on ART.

Methods: We retrospectively analysed data from individuals initiating ART between 2000 and 2015. BMI was calculated at baseline (time of ART initiation). Participants who were non-obese at baseline and had ≥90 days of ART exposure were followed until the development of obesity or the end of follow-up. Obesity incidence rates were estimated using Poisson regression models and risk factors were assessed using Cox regression models.

Results: Of participants analysed at baseline (n = 1794), 61.3% were male, 48.3% were white and 7.9% were obese. Among participants followed longitudinally (n = 1567), 66.2% primarily used an NNRTI, 32.9% a PI and 0.9% an integrase strand transfer inhibitor (INSTI); 18.3% developed obesity and obesity incidence was 37.4 per 1000 person-years. In multivariable analysis, the greatest risk factor for developing obesity was the use of an INSTI as the primary ART core drug (adjusted HR 7.12, P < 0.0001); other risk factors included younger age, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, hypertension and diabetes mellitus.

Conclusions: Obesity following ART initiation is frequent among HIV-infected adults. Key risk factors include female sex, HIV disease severity and INSTI use. Further research regarding the association between INSTIs and the development of obesity is needed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Retroviral Agents / adverse effects*
  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • Antiretroviral Therapy, Highly Active / methods
  • Body Mass Index
  • Brazil / epidemiology
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Obesity / chemically induced*
  • Obesity / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Young Adult


  • Anti-Retroviral Agents