Inflammation and Change in Body Weight with Antiretroviral Therapy Initiation in a Multinational Cohort of HIV-infected Adults.

BACKGROUND

Both wasting and obesity are associated with inflammation, but the extent to which body weight changes influence inflammation in HIV is unknown.

METHODS

Among a random virologically suppressed participants of the PEARLS trial, inflammatory markers were measured at weeks 0, 24, and 48 post-antiretroviral therapy (ART). Associations between baseline and change in body mass index (BMI) and inflammation changes were assessed using random effects models.

RESULTS

Of 246 participants, 27% were overweight/obese (BMI≥25 kg/m(2)) and 8% were underweight (BMI<18.5 kg/m(2)) at baseline. After 48 weeks, 37% were overweight/obese and 3% were underweight. While many inflammatory markers decreased 48 weeks after ART in the overall group, the decrease in CRP was smaller in overweight/obese participants (p=0.01) and the decreases in both CRP (p=0.01) and IL-18 (p=0.02) were smaller in underweight participants. Each 1 unit gain in BMI among overweight/obese participants was associated with a 0.02 log10 increase in sCD14 (p=0.05), while each 1 unit BMI gain among underweight participants was associated with 9.32 mg/L decrease in CRP (p=0.001).

CONCLUSION

Being either overweight or underweight at ART initiation was associated with heightened systemic inflammation. While weight gain among overweight/obese persons predicted increased inflammation, weight gain among underweight persons predicted reduced inflammation.