Body mass index and the risk of serious non-AIDS events and all-cause mortality in treated HIV-positive individuals: D:A:D Cohort analysis

BACKGROUND The relationship between body mass index (BMI) (weight (kg)/ height(m)) and serious non-AIDS events is not well understood. METHODS We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N=41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using poisson regression models, we analysed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5 and 30 kg/m. RESULTS Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (IQR: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of 30 (95% CI) compared to 23-25, respectively, was as follows: CVD: 1.46(1.15-1.84) and 1.31(1.03-1.67); NADCs: 1.78(1.39-2.28) and 1.17(0.88-1.54); 'BMI-NADCs': 1.29(0.66-2.55) and 1.92(1.10-3.36). For all-cause mortality, there was an interaction by gender (P 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.