SAT-093 Effect of HIV Infection and Antiretroviral Therapy Use on Body Weight and Body Weight Changes over a 5-Year Period in US Veterans

Obesity has reached epidemic proportions in the U.S. and is more prevalent in Veterans. Obesity and obesity-related comorbidities are also very common in HIV-infected individuals and HIV- and antiretroviral therapy (ART)-specific factors may contribute to obesity and to the excess morbidity and mortality seen in this population. Our objective was to evaluate the weight trajectory in a retrospective cohort of HIV-infected and HIV-uninfected veterans. We also sought to establish the role of ART in this setting. HIV-infected (n=31,015, 97% male, 36% Caucasian, 52% African American, age 48±11 years) and HIV-uninfected veterans (controls, n=105,801, 96% male, 63% Caucasian, 19% African American, age 48±12 years) were included in the analyses. Variables of interest including body weight, weight change at 1, 2 and 5 years after diagnosis (or corresponding baseline visit for controls), ART use and other covariates (age, race, gender). Data were extracted from the VA Corporate Data Warehouse using laboratory values, medications, vital signs and ICD codes. Body weight at baseline was lower in HIV-infected veterans compared to controls (80±17.7 vs. 92.2±19.9 Kg respectively, p<0.01), and the prevalence of overweight (BMI 25-29.9) and obesity (BMI≥30) was higher in controls (34% and 17% in HIV-infected, 38% and 41% in controls respectively). HIV-infected individuals with a BMI <25 gained more weight at 1, 2 and 5 years post-index date compared to controls with most of these gains taking place at year 1 (3.4±7.8 vs. 2.2±7.1 Kg, 3.9±8.6 vs. 3±8 Kg, 4.4±9.8 vs. 4±9.1 Kg change from baseline at 1, 2 and 5 years respectively, all p<0.01). Although this trend was reversed in overweight individuals at 5 years (1.1±7.1 vs. 0.9±5.6 Kg, p=0.06; 1.3±8.1 vs. 1.4±6.5 Kg, p=0.22; 1.7±9.7 vs. 2.3±8.4 Kg, p<0.01 respectively) and in obese individuals at 2 and 5 years (-0.15±9.7 vs. -0.14±8.2 Kg, p>0.9; -0.29±11.2 vs. 0.19±9.2 Kg, p<0.01; -0.03±13 vs. 1.06±11.6 Kg, p<0.01 respectively). Among HIV-infected individuals, those on ART (n=16,028) gained more weight compared to those not on ART (n=4,392) 1, 2 and 5 years after diagnosis (2.3±8.2 vs. 0.88±7.5 Kg, 2.5±9.1 vs. 1.03±8.9 Kg, 2.8±10.6 vs. 1.65±10.2 Kg, respectively, all p<0.01). The weight increase at 1 year was 2.3±8.2 Kg for those exposed to nucleoside reverse-transcriptase inhibitors (NRTI, n=15,853), 2.2±8 Kg for non-NRTI (n=9,237), 2.7±8.6 Kg for protease inhibitors (n=6,961), 2.8±8.2 Kg for integrase inhibitors (n=1895), 0.01±7.1 Kg for fusion inhibitors (n=50), 2.1±8.4 Kg for CCR5 antagonists (n=63) and 2.4±8.8 Kg for pharmacokinetic enhancers (n=499). HIV infection in veterans is associated with lower rates of obesity at diagnosis and significant weight gain for those with a BMI<25 post-diagnosis. Our data also suggest that exposure to ART (perhaps with the exception of fusion inhibitors) is likely to mediate the increase in body weight seen in this setting.