Potential Link Found Between Reduced QOL, Higher BMI Among PLWH

A major unmet need in the ongoing HIV epidemic is the effect that obesity can have on health-related quality of life (HRQOL), with persons who have HIV now living longer.

Because of this, researchers of a poster presented at IDWeek 2021 indicate that clinicians should consider the potential for a higher BMI and its effect on patients when choosing to manage a person’s HIV, including prescribing ART. Their cross-sectional study incorporated self-reported data from the 2018 and 2019 US National Health and Wellness Survey on 566 persons with a physician-confirmed HIV diagnosis and reported ART use.

HRQOL was evaluated using Short-Form 36-Item (SF-36) Health Survey Version 2 (Mental and Physical Component Summary scores [MCS/PCS]), EQ-5D-5L, and EQ-Visual Analogue Scale (EQ-VAS).

“Weight gain among people living with HIV on ART may lead to obesity,” the authors wrote. “This study evaluated the association between BMI and HRQOL from the patient’s perspective.”

Study participants were also classified by BMI into 3 categories—normal weight (n = 223; 18.5 to < 25 kg/m2), overweight (n = 195; 25 to < 30 kg/m2), and obese (n = 148; > 30 kg/m2)—and 58% were 50 years and older. The highest proportion of participants in each BMI category were White, lived in the South, never smoked but drank alcohol, and had exercised at least once in the previous month. The oldest participants were in the overweight group and the youngest, the normal weight group.

The most common comorbidities were depression in the normal weight group (50.9%) and hypertension in the overweight (51.9%) and obese (48.9%) groups. The highest mean (SD) Charlson Comorbidity Index (CCI) scores also were reported in the obese group (1.28 [1.62[) compared with the overweight (0.71 [1.11]) and normal weight (0/97 [2.77]) groups.

Compared with the normal weight group, a higher proportion of obese patients reported both mobility problems and pain/discomfort. Breaking this down first by EQ-5D-5L areas:

• 57.4% of obese patients reported any mobility issues vs 35.4% and 39.0% in the overweight and normal weight groups
• 52.0% reported any problems with their usual activities vs 37.4% and 45.7%, respectively
• 22.3% vs 16.9% and 17.5 % reported any problems with self-care
• 79.1% vs 63.1% and 65.0% reported pain/discomfort

When looking at the SF-36, although significant differences were not seen in MCS scores, the obese group did report the lowest mean PCS score among the 3 groups: 43.9 (10.7) vs 48.6 (10.0) and 48.7 (9.6) in the overweight and normal weight groups, respectively. EQ-VAS scores were also the lowest in the obese group (63.5 [25.9]) compared with the overweight (69.4 [26/6]) and normal weight (69.3 [24.1]) groups.

In addition, through a multivariate analysis that controlled for age, sex, race, and CCI score, a possible link was noticed between higher BMI and lower PCS (P = .005) and EQ-VAS (P = .014) scores.

The authors concluded that their findings indicate improvements are needed when deciding on a treatment and management plan for persons living with HIV, including choice of antiretroviral treatment, because “the potential for adverse weight gain and transition to higher BMI” may lead to poorer physical health and HRQOL.

Reference

Ken-Opurum J, Prajapati G, Matos JE, Goswami S, Kumar P. Body mass index and quality of life in people with HIV. Presented at: IDWeek; September 29-October 3, 2021. Poster 832.