Endocrine Abstracts

Background: Highly Active Antiretroviral Therapy (HAART) has improved the health and wellbeing of people living with HIV, but at the same time, it causes excessive weight gain through abnormal fat distribution (lipodystrophy). Overweight and obesity have implications on the cardiovascular status of these patients. We aimed to determine the change in BMI after the commencement of HAART and the factors associated with this change.

Methodology: It was a longitudinal prospective study. One hundred and eighty HIV patients that met HAART criteria were recruited before the commencement of therapy. Their weight, height, waist and hip circumferences, blood pressure and laboratory investigations were done. Six months into HAART the anthropometric and laboratory parameters were repeated. Only data of 150 participants were available at the end of the study.

Results: The mean age of the participants was 35.7±10.0 years, and 64% of them were females. Mean BMI pre-HAART was 19.4±5.9 kg/m² while post-HAART mean BMI was 24.0±6.0 kg/m² (P<0.000). Before commencement of HAART, 46.0% of the participants were underweight, 40.0% of normal weight, 10.0% overweight and 4.0% obese. After initiation of HAART, 12.7% were underweight, 55.3% of normal weight, 16.7% overweight and 15.3% obese. The factors associated with increased BMI were impaired fasting glucose, Diabetes, Insulin resistance, raised triglyceride, low HDL, increased waist circumference and waist-hip ratio and metabolic syndrome (P<0.05). There was a statistically significant association between development of obesity and increased CD4 cell count (P=0.007).

Discussion: Exposure to HAART causes stabilization of weight in the majority of the participants and in others they became overweight and obese. This finding is similar what was found in other short-term studies that looked at weight changes following HAART initiation in other parts of the world. Duration of HAART and type of regimen has no effect on this weight change. Weight gain causes metabolic derangement which can cause cardiovascular problems in these patients.

Conclusion: Exposure to HAART causes weight gain and its attendant complications in HIV patients. There is the need for adequate metabolic follow-up for these patients.