1. Melissa Herrin, Jan Tate ScD, MPH & Amy Justice, MD, PhD
Is Weight Gain Associated with Risk of Diabetes Mellitus In HIV Infected Individuals Initiating Combination Antiretroviral Therapy (cART)?
2012
Final Presentation
Melissa Herrin, Jan Tate ScD, MPH & Amy Justice, MD, PhD

2. Weight and HIV Thanks to combination Antiretroviral Therapy (cART):
HIV-associated wasting is rare
Obesity epidemic extends to HIV population
Median weight gain after 12 mos of cART 6.6 lbs
Long-term health implications not yet characterized

3. Weight, Diabetes, and HIV
Obesity and weight gain are risk factors for diabetes in HIV-
Study questions:
Do BMI and weight change predict incident diabetes among HIV positive patients receiving cART?
Do BMI and weight change have a different association with incident diabetes among HIV positive and negative patients?

4. Study Design Veterans Aging Cohort Study (VACS) Virtual Cohort
Patient eligibility criteria
Recorded BMI at baseline and 1 year later
Recorded blood glucose test after baseline
HIV positive patients were cART naïve (HIV-1 RNA >500 copies/mL)
Prevalent diabetes exclusion criteria
Baseline BMI categories

5. Variables & Statistical Analysis
Primary Predictor Variables: Weight gain over 12 months after start date (5 lb increments)
Outcome: Incident diabetes (A1C ≥ 7.0 %)
Statistical Model: Cox Proportional Hazards
cART initiation date
HIV+
DM?
Weight Change
Time until event
Baseline BMI
12 months
First available
BMI
HIV+ 5

6. Baseline patient characteristics
HIV -
HIV +
N = 7766
N = 2939
Age
mean (SD)
50 (10)
48 (10)
Sex
% Male
97.1
96.8
Race (%)
White
43.7
35.6
Black
48.1
55.6
Hispanic/Other 6
CD4
cells/mm3, median (IQR) --
192 (157)
HIV-1 RNA
log copies/mL, median (IQR)
5.3 (5)
BMI
29 (6)
24 (5)
BMI (%)
Underweight <18.5
1.6
7.0
Normal 18.5 to <25
25.4
54.9
Overweight 25 to <30
36.1
28.6
Obese >= 30
36.9
9.5
Smoking (%)
Never
11.0
13.0
Current
32.9
35.5
Former
7.7
8.1
Unknown
48.5
43.5
Present
Hepatitis C Infection
19.7
35.7

7. Weight Change Over 12 Months by Baseline BMI
Weight change over 12 months following start date
Lost > 5 lbs
Remained within ± 5 lbs
Gained > 5 lbs
Baseline BMI

8. Incidence of Diabetes by BMI at Baseline and Weight Gain Over 12 Months
# DM Events
HIV - 13 11
HIV + 2 14 37 38 43 23 8 12 16 73 82 64 4 9

9. Multivariate Risk of Incident Diabetes
Multivariate Risk of Incident Diabetes
Hazard Ratio
95% CI
p value
Sex
Male
1.03
(0.73,1.45)
0.88
Race
Black
1.26
(1.12,1.43)
0.0002
Hispanic
1.13
(0.88,1.46)
0.34
Other
1.20
(0.82,1.76)
Age
Per 5 years
1.09
(1.05,1.12)
<.0001
HIV status
HIV positive status
0.68
(0.56,0.83)
0.0001
Hepatitis C status
Hep C positive
1.19
(1.04,1.37)
0.02
Weight change (per 5 lbs)
HIV-negative
1.04
(1.02,1.07)
HIV-positive
1.11
(1.07,1.15)
Baseline BMI
Underweight
0.67
(0.37,1.21)
0.18
Overweight
1.86
(1.55,2.25)
Obese
4.61
(3.86,5.50)

10. Summary HIV+ gained more weight after cART initiation than HIV-
HIV protective against risk of diabetes after adjustment for weight and other risk factors
Per 5 lb weight gain, HIV-postive patients may be at increased risk for incident diabetes

11. Conclusions / Questions
Could HIV be continuing to exert a physiologic burden decreasing risk of diabetes?
Future investigations: Other indicators of metabolic syndrome including cholesterol, triglycerides, and blood pressure

12. Clinical Conclusion
This analysis suggests that people initiating cART who are not underweight should avoid weight gain in excess of 10 lbs

13. Limitations
Among HIV-positives, those who were normal weight and overweight at baseline powered our analysis
Cohort primarily men – may not be able to draw conclusions to women and demographically dissimilar populations
Weight change over only first12 months after cART initiation – what happens longer term?
Incident diagnostic diabetes criteria: AIC ≥ 7.0%

14. Acknowledgments Dr. Amy Justice Jan Tate VACS Project Team
Amanda, Barbara, Dr. Aronson
We would also like to acknowledge the veterans who participate in the Veterans Aging Cohort Study, the study contributors and staff at each of our sites and the Veterans Affairs Healthcare System. Without the commitment and care of these individuals, this research would not be possible.