Weight evolution and perceptions of adults living with HIV following initiation of antiretroviral therapy in a South African urban setting

Abstract

Background. Obesity and undernutrition are common in South Africa and influence the health outcomes of people living with the human immunodeficiency virus (PLHIV).
Aim. To describe the anthropometric changes and perceptions of body weight in adults initiated on antiretroviral therapy (ART).
Methods. A cohort of 230 PLHIV was enrolled at an HIV clinic in Durban. Changes in their body mass index, and waist and hip girth were measured 6-monthly in the 12 months following initiation of ART. Data on demographic and socio-economic variables, CD4 counts, opportunistic infections and drug regimens used were recorded. Perceptions of body weight and desire to change these were ascertained.
Results. Weight perceptions of respondents were incongruent with their body mass index, with the trend being to judge themselves as weighing less than their actual weight. Those wanting to gain weight gained an average of 7.8 kg – 2.8 times more than those satisfied with their weight (p<0.001). After 12 months on ART, there was a statistically significant increase in anthropometric measurements (p<0.001) with 43 of the 110 women having waist circumferences that increased their risk of cardiovascular disease, the incidence of lipodystrophy was 35% (62/177) (95% confidence interval 27 - 42%), 36% (64/177) were overweight and 22% (39/177) were obese, compared with 21% (49/230) and 12% (28/230) respectively at baseline (p=0.002).
Conclusion. There is a strong association between PLHIV’s perception of body weight, their desire to gain weight and their actual weight gain on ART. Lipodystrophy, weight gain and truncal obesity are common among PLHIV after initiating ART.