ABSTRACT: To determine the association of self-perceived fat gain or fat loss in central and peripheral body sites with adherence to
highly active antiretroviral therapy (HAART) in HIV-seropositive women. 1,671 women from the Women’s Interagency HIV Study
who reported HAART use between April 1999 and March 2006 were studied. Adherence was defined as report of taking HAART≥95%
of the time during the prior 6months. Participant report of any increase or decrease in the chest, abdomen, or upper back
in the prior 6months defined central fat gain and central fat loss, respectively. Report of any increase or decrease in the
face, arms, legs or buttocks in the prior 6months defined peripheral fat gain or peripheral fat loss. Younger age, being
African-American (vs. White non-Hispanic), a history of IDU, higher HIV RNA at the previous visit, and alcohol consumption
were significant predictors of HAART non-adherence (P<0.05). After multivariate adjustment, self-perception of central fat gain was associated with a 1.5-fold increased odds
of HAART non-adherence compared to no change. Self-perception of fat gain in the abdomen was the strongest predictor of HAART
non-adherence when the individual body sites were studied. Women who perceive central fat gain particularly in the abdomen
are at risk for decreased adherence to HAART despite recent evidence to suggest that HIV and specific antiretroviral drugs
are more commonly associated with fat loss than fat gain.
AIDS and Behavior 04/2012; 13(1):53-59. · 3.49 Impact Factor
ABSTRACT: Since the introduction of highly active antiretroviral therapy (HAART) and the subsequent increased life expectancy in HIV-infected persons, non-HIV-related diseases have become an important cause of morbidity and mortality. This cross-sectional study reports the prevalence of overweight and obesity, and sociodemographic, psychological, and substance use-related risk factors for elevated body mass index (BMI) among 2157 HIV-seropositive (HIV+) in comparison to 730 HIV-seronegative (HIV-) participants in the Women's Interagency HIV Study (WIHS). Separate univariable and multivariate linear regression analyses were completed for HIV+ and HIV- women. Our study revealed a similar proportion of obesity (body mass index [BMI] >or=30) among HIV+ (33%) and HIV- women (29%) (p = 0.12), as well as comparable median BMI (HIV+: 26.1 versus HIV-: 26.7, p = 0.16). HIV+ compared to HIV- women, respectively, were significantly (p < 0.01) older (median = 35.6 versus. 32.5), but similar (p = 0.97) by race/ethnicity (57% African American, 28% Hispanic, and 15% white for both). In multivariate models for both HIV+ and HIV- women, African American race/ethnicity was significantly (p < 0.05) associated with higher BMI, while higher quality of life score and illicit hard drug use were associated with lower BMI. Additionally, smoking, alcohol use, markers of advanced HIV infection (AIDS diagnosis, elevated HIV viral load, low CD4 count), and a history of antiretroviral therapy use (ART) were also associated with lower BMI among HIV+ women. In conclusion, risk factors for elevated BMI were similar for HIV+ and HIV- women in the WIHS. For HIV+ women, all markers of advanced HIV infection and ART use were additionally associated with lower BMI.
AIDS patient care and STDs 11/2009; 23(12):1009-16. · 2.68 Impact Factor
ABSTRACT: Antiretroviral (ARV) therapies fail when behavioral or biologic factors lead to inadequate medication exposure. The currently available methods to assess ARV exposure are limited. Levels of ARVs in hair reflect plasma concentrations over weeks to months, and may provide a novel method for predicting therapeutic responses.
The Women's Interagency HIV Study, a prospective cohort of HIV-infected women, provided the basis for developing and assessing methods to measure commonly prescribed protease inhibitors (lopinavir/ritonavir and atazanavir) in small hair samples. We examined the association between hair protease inhibitor levels and initial virologic responses to therapy in multivariate logistic regression models.
ARV concentrations in hair were strongly and independently associated with treatment response for 224 women starting a new protease inhibitor-based regimen. For participants initiating lopinavir/ritonavir, the odds ratio (OR) for virologic suppression was 39.8 [95% confidence interval (CI) = 2.8-564] for those with lopinavir hair levels in the top tertile (>1.9 ng/mg) compared to the bottom (</=0.41 ng/mg) when controlling for self-reported adherence, age, race, starting viral load and CD4 cell count, and prior experience with protease inhibitors. For women starting atazanavir, the adjusted OR for virologic success was 7.7 (95% CI = 2.0-29.7) for those with hair concentrations in the top tertile (>3.4 ng/mg) compared to the lowest (</=1.2 ng/mg).
Protease inhibitor levels in small hair samples were the strongest independent predictor of virologic success in a diverse group of HIV-infected adults. This non-invasive method for determining ARV exposure may have particular relevance for the epidemic in resource-poor settings due to the ease of collecting and storing hair.
AIDS (London, England) 01/2009; 23(4):471-8. · 4.91 Impact Factor
ABSTRACT: To assess the prevalence of metabolic syndrome (MetSynd) among participants of the Women's Interagency HIV Study and to describe the association of MetSynd with HIV infection, antiretroviral therapies, and sociodemographic factors.
Prevalence of MetSynd, defined by updated Adult Treatment Panel III guidelines, was assessed among 2393 (1725 seropositive and 668 seronegative) participants from the Women's Interagency HIV Study seen between October 2000 and October 2004.
HIV-1 infection was independently associated with MetSynd [33% vs 22%, P<0.0001 in HIV-seropositive compared with HIV-seronegative women; adjusted odds ratio (OR) 1.79 (95% confidence interval 1.48, 2.16)]. HIV-infected women had higher mean triglyceride (154 vs 101 mg/dL, P<0.0001) and lower mean high-density lipoprotein cholesterol levels (46 vs 55 mg/dL, P<0.0001). Most notable factors associated with higher prevalence of MetSynd among HIV-infected women included older age (OR=1.38 per 5 year increase, P<0.0001); higher body mass index; current smoking; HIV-1 RNA (OR=1.36, P=0.019, for >50,000 vs <80 copies/mL); and use of stavudine (OR=1.28, P=0.009). Nevirapine use was protective (OR=0.75, P=0.016). There was no significant association of MetSynd with ritonavir-boosted protease inhibitors (OR=1.15, P=0.134).
MetSynd is more prevalent in HIV-seropositive than HIV-seronegative women. This increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference.
JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2008; 48(3):272-80. · 4.43 Impact Factor
ABSTRACT: Previous studies suggest that indicators of central adiposity such as waist-to-hip ratio (WHR) and waist circumference may be altered by HIV infection, antiretroviral treatment, or both.
Waist and hip circumference and body mass index (BMI) were measured among participants of the Women's Interagency HIV Study semiannually from 1999 to 2004. Generalized linear models evaluated longitudinal patterns of these measures and associations with demographic and clinical characteristics.
WHR was significantly larger, whereas BMI and waist and hip circumference were significantly smaller at almost all 11 semiannual visits among 942 HIV-infected women compared with 266 HIV-uninfected women. Among HIV-uninfected women, mean waist and hip circumference and BMI increased over the 5-year study period (waist: +4.1 cm or 4.4%, hip: +3.76 cm or 3.5%, and BMI +2.43 kg/m2 or 8.2%), whereas WHR remained stable. Among the HIV-infected women, waist and hip circumference, BMI, and WHR did not significantly change. Independent predictors of smaller BMI among HIV-infected women included white race, hepatitis C virus seropositivity, current smoking, higher viral load, and lower CD4 cell count. Independent predictors of larger WHR among HIV-infected women included age, white and other non-African American race, higher CD4 cell count, and protease inhibitor (PI) use. Use of a highly active antiretroviral therapy (HAART) regimen was not an independent predictor of BMI or WHR.
HIV-infected women had higher WHRs compared with HIV-uninfected women, despite lower BMIs and waist and hip measurements. BMI and waist and hip circumference increased over 5 years among the HIV-uninfected women but remained stable in the HIV-infected women. Among HIV-infected women, PI use was associated with a larger WHR, although HAART use itself was not appreciably associated with BMI or WHR.
JAIDS Journal of Acquired Immune Deficiency Syndromes 04/2008; 47(3):312-9. · 4.43 Impact Factor
ABSTRACT: We previously demonstrated that HIV infection is associated with peripheral and central lipoatrophy in women. We now describe the association of specific antiretroviral drugs (ARV) with body fat changes over a four-year period from 1999 to 2003. 775 HIV-positive and 205 HIV-negative women in the Women's Interagency HIV Study with anthropometric measurements, weight, bioelectric impedance analysis and ARV collected semiannually were included in analysis. Exposure to ARV was defined as report of use for 3 consecutive semiannual study visits. The average 6-month change in weight, percent total body fat, and circumference measurements (i.e., hip, waist, chest, arm, and thigh) was compared between those exposed and those unexposed to the specific ARV for any of the same three consecutive visits. Weight, percent total body fat, and hip, waist, thigh, chest, and arm circumferences decreased in HIV-positive women, but increased in HIV-negative women on average for every six-month interval over the 4-year study period. Among the HIV-positive women, didanosine was the only ARV associated with decreases in circumference measures in the hip (-0.65 cm, 95% confidence interval [CI]: -1.18, -0.12), waist (-0.71 cm, 95% CI: -1.37, -0.04), chest (-0.71 cm, 95% CI: -1.17, -0.26), and arm (-0.23 cm, 95% CI: -0.48, 0.03; p = 0.08). These prospective data suggest that fat loss continues to predominate in HIV-positive women and exposure to didanosine for at least 12 months may further worsen fat loss.
AIDS PATIENT CARE and STDs 06/2007; 21(5):297-305. · 2.41 Impact Factor