Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen: Effects of sex and race

Priya Bhagwat, Ighovwerha Ofotokun, Grace A. McComsey, Todd T Brown, Carlee Moser, Catherine A. Sugar, Judith S. Currier

Research output: Contribution to journalArticle

Abstract

Background. This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods. We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results. The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions. With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Volume5
Issue number11
DOIs
StatePublished - Jan 1 2018

Fingerprint

Waist Circumference
Protease Inhibitors
Ritonavir
HIV
Abdominal Fat
Tenofovir
Demography
Therapeutics
Raltegravir Potassium
Viral Load
Causality
Randomized Controlled Trials
Logistic Models
Health
Population
Darunavir

Keywords

  • Abdominal fat
  • Central adiposity
  • Lipodystrophy
  • Metabolic complications
  • Waist circumference

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen : Effects of sex and race. / Bhagwat, Priya; Ofotokun, Ighovwerha; McComsey, Grace A.; Brown, Todd T; Moser, Carlee; Sugar, Catherine A.; Currier, Judith S.

In: Open Forum Infectious Diseases, Vol. 5, No. 11, 01.01.2018.

Research output: Contribution to journalArticle

Bhagwat, Priya ; Ofotokun, Ighovwerha ; McComsey, Grace A. ; Brown, Todd T ; Moser, Carlee ; Sugar, Catherine A. ; Currier, Judith S. / Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen : Effects of sex and race. In: Open Forum Infectious Diseases. 2018 ; Vol. 5, No. 11.
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abstract = "Background. This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods. We analyzed data from ACTG A5257, a clinical trial that randomized treatment-na{\"i}ve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results. The study population (n = 1809) was 76.0{\%} male and predominantly black non-Hispanic (41.9{\%}) and white non-Hispanic (34.1{\%}). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions. With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.",
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T1 - Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen

T2 - Effects of sex and race

AU - Bhagwat, Priya

AU - Ofotokun, Ighovwerha

AU - McComsey, Grace A.

AU - Brown, Todd T

AU - Moser, Carlee

AU - Sugar, Catherine A.

AU - Currier, Judith S.

PY - 2018/1/1

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N2 - Background. This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods. We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results. The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions. With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.

AB - Background. This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods. We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results. The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions. With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.

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KW - Central adiposity

KW - Lipodystrophy

KW - Metabolic complications

KW - Waist circumference

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