Obesity Following Antiretroviral Therapy (ART) Initiation is Common and Influenced by Both Traditional and HIV-/ART-Specific Risk Factors

Abstract Background Weight gain commonly occurs among HIV-infected (HIV+) adults initiating modern ART regimens, and obesity is increasingly reported in this population. However, data regarding specific risk factors for obesity development after ART initiation are conflicting. Methods We retrospectively analyzed data from a cohort of HIV+ adults who initiated ART between January 1, 2000 and December 31, 2015 in Rio de Janeiro, Brazil. Body mass index (BMI) was assessed at ART initiation. Participants who were non-obese (BMI < 30kg/m2) at baseline and had ≥90 days of ART exposure were followed for development of obesity. Participants were censored at the time of obesity diagnosis or at end of follow-up (defined as death, loss to follow-up, end of study period or 2 years after their last weight measurement). Incidence rates were estimated using Poisson regression models and risk factor assessment was calculated using Cox regression models accounting for death and loss to follow-up as competing risks. Results Participants (n = 1,794) were 61.3% male, 48.3% white and had a median age of 36.3 years. At ART initiation, participants had a median BMI of 22.6kg/m2 and BMI category distribution was: underweight 14%, normal weight 56%, overweight 22% and obese 8%. Of the 1,567 non-obese participants followed after ART initiation, 76% gained weight, 44% increased their BMI category and 18% developed obesity. Median BMI at the end of follow-up was 24.7kg/m2 (0.4kg/m2 median annual change), the obesity incidence rate was 37.4 per 1000 person-years and the median time to obesity diagnosis was 1.9 years (vs. 4.7 years of follow-up for participants remaining non-obese). Factors associated with obesity after ART initiation included younger age at ART initiation, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, having an integrase inhibitor as the most-used ART core drug and having diagnoses of hypertension and diabetes mellitus (Figure). Conclusion Obesity following ART initiation is frequent among HIV+ adults, with rates increasing in recent years. Both traditional (female sex) and HIV-specific (more advanced HIV disease, integrase inhibitor use) risk factors contribute importantly to obesity incidence following ART initiation. Disclosures All authors: No reported disclosures

Substance use among HIV-infected patients in Rio de Janeiro, Brazil: Agreement between medical records and the ASSIST questionnaire.

BackgroundSubstance use assessment is a challenge in busy clinical settings that may adversely affect HIV-infected persons. This study aimed to evaluate agreement between the medical chart and a standardized substance use screening questionnaire.MethodsOf adults (n=1050) in HIV care in Rio de Janeiro who completed the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), we randomly selected 200 participants for medical chart review. Lifetime use of tobacco, alcohol, marijuana, and cocaine agreement between the medical record and ASSIST was evaluated using Kappa statistics. Sensitivity and specificity of chart information were also calculated.ResultsThe median age was 42.4 years, 60.3% were male and 49.5% were white. Prevalence of lifetime use reported in ASSIST was 55.3% (tobacco), 79.4% (alcohol), 23.1% (marijuana), and 20.7% (cocaine). Any information on lifetime use was found in the medical chart for tobacco (n=180, 90.5%), alcohol (n=183, 92.0%), marijuana (n=143, 71.8%), and cocaine (n=151, 75.9%). The Kappa statistic, sensitivity and specificity of the medical chart accurately identifying lifetime substance users per ASSIST were respectively 0.60, 0.71, and 0.91 for tobacco; 0.22, 0.75, and 0.51 for alcohol; 0.58, 0.51, and 0.98 for marijuana; and 0.73, 0.75, and 0.96 for cocaine.ConclusionConsidering inaccuracies in the medical chart, the implementation of brief, standardized substance use screening is recommended in HIV care settings

Substance use among HIV-infected patients in Rio de Janeiro, Brazil: Agreement between medical records and the ASSIST questionnaire.

BackgroundSubstance use assessment is a challenge in busy clinical settings that may adversely affect HIV-infected persons. This study aimed to evaluate agreement between the medical chart and a standardized substance use screening questionnaire.MethodsOf adults (n=1050) in HIV care in Rio de Janeiro who completed the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), we randomly selected 200 participants for medical chart review. Lifetime use of tobacco, alcohol, marijuana, and cocaine agreement between the medical record and ASSIST was evaluated using Kappa statistics. Sensitivity and specificity of chart information were also calculated.ResultsThe median age was 42.4 years, 60.3% were male and 49.5% were white. Prevalence of lifetime use reported in ASSIST was 55.3% (tobacco), 79.4% (alcohol), 23.1% (marijuana), and 20.7% (cocaine). Any information on lifetime use was found in the medical chart for tobacco (n=180, 90.5%), alcohol (n=183, 92.0%), marijuana (n=143, 71.8%), and cocaine (n=151, 75.9%). The Kappa statistic, sensitivity and specificity of the medical chart accurately identifying lifetime substance users per ASSIST were respectively 0.60, 0.71, and 0.91 for tobacco; 0.22, 0.75, and 0.51 for alcohol; 0.58, 0.51, and 0.98 for marijuana; and 0.73, 0.75, and 0.96 for cocaine.ConclusionConsidering inaccuracies in the medical chart, the implementation of brief, standardized substance use screening is recommended in HIV care settings

Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study.

Self-rated health (SRH) is associated with morbidity and mortality in HIV-uninfected populations but is understudied in HIV. Substance use may affect SRH in addition to its deleterious effect on HIV disease. This analysis aimed to estimate SRH and substance use prevalence and evaluate factors associated with poor SRH among individuals in HIV care in Rio de Janeiro, Brazil. A convenience sample of HIV-infected adults completed one item of SRH, the Alcohol, Smoking and Substance Involvement Screening Test, and the Patient Health Questionnaire-2 (PHQ-2). Logistic regression models identified factors associated with poor SRH. Participants' (n = 1029) median age was 42.9 years, 64.2% were male, and 54.5% were nonwhite. Poor SRH was reported by 19.5% and the use of alcohol, tobacco, marijuana, and crack/cocaine by 30.1, 19.5, 3.9, and 3.5%, respectively. Less than high school education (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI]: 1.08-2.20), lack of sexual activity in previous 12 months (aOR 1.53, 95% CI: 1.01-2.30), crack/cocaine use (aOR 3.82, 95% CI: 1.80-8.09), positive PHQ-2 screen (aOR 3.43, 95% CI: 2.09-5.62), and HIV-1 RNA ≥40 c/ml (aOR 2.51, 95% CI: 1.57-4.02) were significantly associated with poor SRH as identified by logistic regression analyses. Alcohol, marijuana, and sedative use were not significantly associated with poor SRH. These results emphasize the need for substance use and mental health screening and treatment in this population. Further research may elucidate the consequences of poor SRH on treatment adherence, morbidity, and mortality in HIV-infected individuals

Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors.

Background:Obesity rates are increasing among HIV-infected individuals, but risk factors for obesity development on ART remain unclear. Objectives:In a cohort of HIV-infected adults in Rio de Janeiro, Brazil, we aimed to determine obesity rates before and after ART initiation and to analyse risk factors for obesity on ART. Methods:We retrospectively analysed data from individuals initiating ART between 2000 and 2015. BMI was calculated at baseline (time of ART initiation). Participants who were non-obese at baseline and had ≥90 days of ART exposure were followed until the development of obesity or the end of follow-up. Obesity incidence rates were estimated using Poisson regression models and risk factors were assessed using Cox regression models. Results:Of participants analysed at baseline (n = 1794), 61.3% were male, 48.3% were white and 7.9% were obese. Among participants followed longitudinally (n = 1567), 66.2% primarily used an NNRTI, 32.9% a PI and 0.9% an integrase strand transfer inhibitor (INSTI); 18.3% developed obesity and obesity incidence was 37.4 per 1000 person-years. In multivariable analysis, the greatest risk factor for developing obesity was the use of an INSTI as the primary ART core drug (adjusted HR 7.12, P < 0.0001); other risk factors included younger age, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, hypertension and diabetes mellitus. Conclusions:Obesity following ART initiation is frequent among HIV-infected adults. Key risk factors include female sex, HIV disease severity and INSTI use. Further research regarding the association between INSTIs and the development of obesity is needed

Retention in Early Care at an HIV Outpatient Clinic in Rio de Janeiro, Brazil, 2000-2013.

Retention in early HIV care has been associated with virologic suppression and improved survival, but remains understudied in Brazil. We estimated retention in early HIV care for the period 2000-2013, and identified socio-demographic and clinical factors associated with good retention in an urban cohort from Rio de Janeiro, Brazil. Antiretroviral therapy-naïve, HIV-infected persons ≥18 years old linked to care between 2000 and 2011 were included. Retention in the first 2 years post-linkage (i.e. early care) was defined by the proportion of 6-month intervals with ≥1 HIV laboratory result. "Good" retention was defined as ≥1 HIV laboratory result recorded in at least three intervals. Overall, 80 % of participants met criteria for good retention and retention significantly improved over the study period. Older age, higher education level and early antiretroviral therapy initiation were associated with good retention. Efforts to improve retention in early care in this population should target younger and less-educated HIV-infected persons