Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana.

An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI >= 25 kg/m(2)) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naive, HIV+ adults included 217 participants, 139 with BMI of 18.0-24.9 kg/m(2) and seventy-eight participants with BMI >= 25 kg/m(2). The primary outcome was time to event (>= 25% decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count <250 cells/mu l and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0.218; 95% CI 0.068, 0.701; P = 0.011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0.855; 95% CI 0.741, 0.987; P = 0.033) and the combined outcome of having CD4 cell count <= 250/mu l and AIDS-defining conditions, whichever occurred earlier (HR 0.918; 95% CI 0.847, 0.994; P = 0.036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naive participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.