Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Public Health Sciences, 2016.
Background: Within developed nations, the HIV-infected population has seen increases in life expectancy and non-AIDS related causes of morbidity including excess body mass index (BMI). There is some support for associations between highly active antiretroviral therapy (HAART) and short-term BMI change, but long-term associations remain unclear. It is also possible for BMI to interact with HAART regimens to further increase the risk for diabetes, hypertension, and dyslipidemia. Excess BMI could further negatively affect characteristics including quality of life (QoL) similar to the general population. Objectives: Assess whether long-term HAART use impacts cardiometabolic risk, including but not limited to excess BMI, and does the presence of excess BMI further impact the development of other cardiometabolic risk factors (CVD risk factors) and QoL among HIV-infected patients. Methods: Participants were identified via an HIV registry (n=733) or directly recruited (n=153) at Strong Memorial Hospital in Rochester, NY. Longitudinal analyses assessed trends in CVDRF markers, the relationships between HAART and BMI, and the presence of an interaction on changes in diabetes, hypertension, and dyslipidemia markers. The relationship between excess BMI and QoL was examined with linear regression and accounted for body image. Results: Since 1996, the average BMI has been consistently above the normal range (18.5-24.9). Though BMI changes were significant during short and long-term treatment periods, the difference in this change was not significant after controlling for patient demographics and health. The interaction between BMI and HAART regimens was also significantly associated with changes in blood pressure and cholesterol levels. Additionally, elevated BMI was significantly associated with lower QoL prior to accounting for body image. All findings showed variations across racial/ethnic groups. Conclusion: HAART regimens do not appear to be the driving factor of BMI change during the first two years of treatment. The interactions between BMI and HAART regimens on changes in markers for hypertension and dyslipidemia fail to yield clinically significant results. In addition, the QoL assessment identified a complex relationship between QoL, BMI, and body image, which should be accounted for during the development of weight loss/management interventions for the HIV-infected population.
