High risk of obesity and weight gain for HIV-infected uninsured minorities.
High risk of obesity and weight gain for HIV-infected uninsured minorities.
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DOI：
10.1097/qai.0000000000000010
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发表时间：
2014-02-01
期刊：
影响因子：
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通讯作者：
Turner BJ
中科院分区：
文献类型：
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作者：
Taylor BS;Liang Y;Garduño LS;Walter EA;Gerardi MB;Anstead GM;Bullock D;Turner BJ
肥胖和艾滋病毒不成比例地影响少数群体，并具有重大的健康风险，但很少有研究探讨艾滋病毒血清阳性（艾滋病毒+）队列中体重变化的差异。确定主要为西班牙裔HIV+队列中体重显著增加的种族和健康保险差异。我们在2007-2010年对1，214名非体重不足的HIV+成人进行的观察性队列研究的主要结局是体重显著增加（每年BMI增加≥3%）。次要结局是随时间推移的连续BMI。一个四个层次的种族-民族/保险预测反映了种族-民族和保险之间的相互作用：投保的白色（非西班牙裔），未投保的白色，投保的少数民族（西班牙裔或黑人），或未投保的少数民族。Logistic和混合效应模型调整了以下因素：基线BMI;年龄;性别;家庭收入; HIV传播类别;抗逆转录病毒治疗类型; CD 4+计数;血浆HIV-1 RNA;观察月数;访视频率。该队列是63%的西班牙裔和14%的黑人; 13.3%的投保白色，10.0%未投保白色，40.9%投保的少数民族，35.7%未投保的少数民族。基线时，37.5%超重，22.1%肥胖。中位观察时间为3.25年。24.0%的患者体重显著增加，未投保的少数民族患者比投保的白人患者更有可能出现体重显著增加（调整后的比值比=2.85，95%CI：1.66，4.90）。在混合效应模型中，没有保险的少数民族的BMI增加率最高。在基线时超重的455人中，29%预计在4年内变得肥胖。在这个大多数西班牙裔HIV+队列中，60%的基线超重或肥胖，未投保的少数民族患者体重增加更快。这些数据应该促使艾滋病毒提供者更加关注预防肥胖。
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 1,214 non-underweight HIV+ adults from 2007-2010 had significant weight gain (≥3% annual BMI increase) as primary outcome. The secondary outcome was continuous BMI over time. A four-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. 24.0% had significant weight gain, which was more likely for uninsured minority patients than insured whites (adjusted odds ratio=2.85 , 95%CI: 1.66, 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 to prevention of obesity.