Adipose tissue affects several aspects of the cellular immune system, but prior epidemiological studies have differed on whether a higher body mass index (BMI) promotes CD4 T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count. We used the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data set to analyse the relationship between pre-treatment BMI and 12-month CD4 T-cell recovery among adults who started ART between 1998 and 2010 and maintained HIV-1 RNA levels 400 copies/mL for at least 6 months. Multivariable regression models were adjusted for age, race, sex, baseline CD4 count and HIV RNA level, year of ART initiation, ART regimen and clinical site. A total of 8381 participants from 13 cohorts contributed data; 85% were male, 52% were nonwhite, 32% were overweight (BMI 25-29.9?kg/m(2) ) and 15% were obese (BMI >?30?kg/m(2) ). Pretreatment BMI was associated with 12-month CD4 T-cell change (P?0.001), but the relationship was nonlinear (P?0.001). Compared with a reference of 22?kg/m(2) , a BMI of 30?kg/m(2) was associated with a 36?cells/?L [95% confidence interval (CI) 14, 59?cells/?L] greater CD4 T-cell count recovery among women and a 19?cells/?L (95% CI 9, 30?cells/?L) greater recovery among men at 12 months. At a BMI?>?30?kg/m(2) , the observed benefit was attenuated among men to a greater degree than among women, although this difference was not statistically significant. A BMI of approximately 30?kg/m(2) at ART initiation was associated with greater CD4 T-cell recovery at 12 months compared with higher or lower BMI values, suggesting that body composition may affect peripheral CD4 T-cell recovery.
Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010
Authors: Koethe JR; Silverberg MJ; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD); et al.
HIV Med. 2015 Oct;16(9):572-7. Epub 2015-05-11.