Obesity is a risk factor for co-occuring chronic health problems in patients with HIV

Michael Carter
Published: 10 October 2012

Obesity is associated with the clustering of multiple health problems in HIV-positive people, investigators from the US report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Compared to people of a healthy weight, obese individuals were 50% more likely to have multiple health problems such as metabolic disturbances and mood disorders.

“Obesity was associated with a significantly higher likelihood of multimorbidity,” comment the investigators. “The issue of weight management must be stressed in longitudinal care in order to diminish its impact on multimorbidity among HIV-infected patients.” 

The diseases of ageing are an increasingly important cause of serious illness and death in people with HIV. An increasing number of HIV-positive individuals are living with two or more chronic health conditions in different disease areas. This clustering of multiple health conditions is often called 'multimorbidity' and in the general population has been shown to have serious long-term implications.

Another emerging health problem for HIV-positive people in the US is obesity. Research conducted by at the HIV clinic of the University of Alabama at Birmingham showed that 45% of patients not yet taking antiretroviral therapy were overweight or obese.

Investigators at the clinic wanted to see how many of their patients had multiple chronic diseases and if this was associated with obesity.

They therefore reviewed the records of 1844 adult patients who received care between July 2010 and June 2011. All were taking antiretroviral therapy.

Chronic diseases were clustered into three broad areas:

  • Metabolic – hypertension, gout, diabetes mellitus, chronic kidney disease.
  • Behavioural – mood disorders, high lipids, chronic obstructive pulmonary disease, chronic ulcer disease, arthritis, chronic sleep apnoea and cardiac disorders.
  • Substance use – alcohol and drug abuse, smoking and hepatitis C co-infection.

Participants were grouped into four weight categories according to their BMI:

  • Underweight – below 18.5 kg/m2.
  • Normal weight – 18.5 to 24.9 kg/m2.
  • Overweight – 25 to 29.9 kg/m2.
  • Obese – 30 kg/m2 and above.

The investigators performed a series of statistical analyses to see if obesity and certain other risk factor were associated with the presence of diseases from more than one cluster.

Over three-quarters (77%) of participants were men, their mean age was 44 years and 46% were white. Most people (71%) had a CD4 cell count above 350 cells/mm3.

Almost two-thirds of participants were overweight (36%) or obese (29%).

Overall, 65% of participants had chronic diseases from two or more of the disease clusters. The prevalence of multiple morbidity increased with each progressive BMI category: underweight, 56%; normal weight, 62%; overweight, 67%; obese, 69%.

Compared to people with a healthy weight, obese individuals were significantly more likely to develop a chronic condition from two or more disease clusters (OR = 1.52; 95% CI, 1.15-2.00). “Conditions such as obesity and dyslipidemia in particular, once considered to be a side-effect of ART [antiretroviral therapy], are now observed as baseline condition for treatment-naïve HIV-infected patients…and play a key role in multimorbidity,” comment the authors.

Increasing age was also a risk factor for the presence of multiple health problems (each ten-year increase, OR = 1.81; 95% CI, 1.62-2.02). “Increased longevity among well-managed HIV patients will likely contribute to higher rates of multimorbidity in the future and will play a key role in the evolving needs of our patients population,” suggest the investigators.

They conclude: “The impact of ageing, obesity and increasing prevalence of multimorbidity in the HIV-infected population will have far reaching implications…our attempt to characterize multimorbidity patterns and observe commonly co-occurring conditions will provide critical first steps in further defining the scope of the problem, and inform interventions to address the management of multimorbidity in the context of HIV.”


Kim DJ et al. Multimorbidity patterns in HIV-infected patients: the role of obesity in chronic disease clustering. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e31827303d5, 2012.

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