High risk of obesity and weight gain for HIV-infected uninsured minorities

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 65; no. 2; pp. e33 - e40
• Main Authors: Taylor, Barbara S, Liang, Yuanyuan, Garduño, L Sergio, Walter, Elizabeth A, Gerardi, Margit B, Anstead, Gregory M, Bullock, Delia, Turner, Barbara J
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins Ovid Technologies 01-02-2014
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS/HIV; Body Mass Index; Cohort Studies; Female; HIV; HIV Infections - complications; HIV-1; Human immunodeficiency virus; Humans; Male; Medically Uninsured; Middle Aged; Minority & ethnic groups; Minority Groups; Obesity; Obesity - epidemiology; Risk Assessment; Uninsured people; Weight control; Weight Gain
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0000000000000010

Obesity and HIV disproportionately affect minorities and have significant health risks, but few studies have examined disparities in weight change in HIV-seropositive (HIV+) cohorts.
To determine racial and health insurance disparities in significant weight gain in a predominately Hispanic HIV+ cohort.
Our observational cohort study of 1214 nonunderweight HIV+ adults from 2007 to 2010 had significant weight gain [≥3% annual body mass index (BMI) increase] as the primary outcome. The secondary outcome was continuous BMI over time. A 4-level race-ethnicity/insurance predictor reflected the interaction between race-ethnicity and insurance: insured white (non-Hispanic), uninsured white, insured minority (Hispanic or black), or uninsured minority. Logistic and mixed-effects models adjusted for baseline BMI, age, gender, household income, HIV transmission category, antiretroviral therapy type, CD4 count, plasma HIV-1 RNA, observation months, and visit frequency.
The cohort was 63% Hispanic and 14% black; 13.3% were insured white, 10.0% uninsured white, 40.9% insured minority, and 35.7% uninsured minority. At baseline, 37.5% were overweight, 22.1% obese. Median observation was 3.25 years. Twenty-four percent of the cohort had significant weight gain, which was more likely for uninsured minority patients than insured whites [adjusted odds ratio = 2.85, 95% confidence intervals (CIs): 1.66 to 4.90]. The rate of BMI increase in mixed-effects models was greatest for uninsured minorities. Of 455 overweight at baseline, 29% were projected to become obese in 4 years.
In this majority Hispanic HIV+ cohort, 60% were overweight or obese at baseline, and uninsured minority patients gained weight more rapidly. These data should prompt greater attention by HIV providers for prevention of obesity.