The prevalence of being overweight and obesity and the effect of exercise in a HIV‐positive population
Authors: Kyriakidou E. 
Published: May 2009

Background:  Highly‐active antiretroviral therapy (HAART) has led to substantial reductions of the morbidity and mortality of HIV infection (Palella et al., 1998). However, the use of HAART has been associated with morphological and metabolic complications, placing HIV‐positive patients at greater risk of developing diseases such as obesity, cardiovascular disease, diabetes and the metabolic syndrome (Carr et al., 1998). Exercise has been proposed as a therapeutic option for the metabolic abnormalities observed in the HIV population (Robinson et al., 2007). The aims of this research were: (i) to determine the prevalence of being overweight and obesity in HIV‐infected adults receiving HAART because, to date, no systematic review has been conducted on that area and (ii) to identify the effects of a structured exercise programme on metabolic and fitness parameters that will contribute further to the existing body of research.

Methods:  A systematic review was undertaken to summarise the reported prevalence of being overweight and obesity in adult HIV‐positive HAART‐users. Studies were obtained from computerised searches of electronic bibliographic databases (n = 9) and were included only if they reported the prevalence of being overweight and/or obesity according to the World Health Organization criteria for body mass index (BMI) classification. A retrospective data analysis was performed on 17 HIV‐positive patients who had participated in the ‘Positive Moves’ exercise programme between January 2001 to January 2008. The variables included in the analysis were weight, BMI, total cholesterol, low‐density lipoprotein‐cholesterol (LDL‐C), high‐density lipoprotein‐cholesterol (HDL‐C), triglycerides, glucose, resting heart rate, vo2 max, handgrip strength and flexibility. Eligible patients had data at two timepoints. Mean length of the exercise programme was 140 days. Paired‐samples t‐tests and Wilcoxon signed rank tests were used to compare results from baseline to the end of the programme.

Results:  The combined prevalence of being overweight and obesity was in the range 30.5–52.9%. The separate prevalences of being overweight and obesity were 25.6–38.6% and 3.2–19% respectively. The results of the retrospective data analysis are shown in Table 1.

 Characteristics of HIV‐HAART users

Variable
Total n (%)
Mean (SD)
P

Weight
17
(100)
 0.64 (5.47)
0.633

BMI
16
 (94)
 0.09 (1.84)
0.844

Total cholesterol
15
 (88)
 0.18 (0.91)
0.455

LDL‐C
 4
 (24)
 0.25 (0.38)
0.286

HDL‐C
 4
 (24)
 0.15 (0.18)
0.188

Triglycerides
15
 (88)
−0.02 (0.77)
0.916

Glucose
13
 (76)
−0.20 (1.22)
0.566

RHR
16
 (94)
−1.50 (10.51)
0.576

VO2 max
16
 (94)
−5.48 (7.31)
0.009

Handgrip strength
14
 (82)
−1.60 (4.07)
0.165

Sit‐reach hip flexion
10
 (59)
−2.30 (2.49)
0.017

*Percentages in each category are expressed as percentage of the total number of the final sample.

Discussion:  The findings of the systematic review suggest that there is a high prevalence of being overweight and obesity in patients taking HAART. A structured exercise programme did not have a significant impact on metabolic and some fitness parameters; however, the lack of effect may be due to the small sample size.

Conclusions:  These findings suggest that effective interventions are needed to manage the morphological and metabolic complications associated with taking HAART. Future studies could focus on the effects of exercise on self‐esteem and confidence because patients may feel better in themselves through improvements in VO2 max and flexibility.

References  Carr, A., Samaras, K., Burton, S., law, M., Freund, J., Chisolm, D.J. & Cooper, D.A. (1998) A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS12, F51–58.

Palella, F.J., Jr. Delaney, K.M., Moorman, A.C., Loveless, M.O., Fuhrer, J., Satten, G.A., Aschman, D.J. & Holmberg, S.D. (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N. Engl. J. Med.338, 853–860.

Robinson, F.P., Quinn, L.T. & Rimmer, J.H. (2007) Effects of high‐intensity endurance and resistance exercise on HIV metabolic abnormalities: a pilot study. Biol. Res. Nurs.8, 177–185.