Objectives: Among older people living with HIV (PLWH) and comparable individuals without HIV, we evaluated whether associations of HIV and antiretroviral therapy (ART) with disability depend on body mass index (BMI). Methods: We analyzed 4552 participants in the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa.” (HAALSI) We compared prevalence of disability (≥1 impairment in basic activities of daily living) by HIV status, ART use, and BMI category, adjusting for age, sex, education, father’s occupation, country of origin, lifetime alcohol use, and primary health-care utilization. Results: Among PLWH, those underweight had 9.8% points (95% confidence interval (CI): 1.2 to 18.4) higher prevalence of disability than those with normal BMI. Among ART users, those underweight had 11.9% points (95% CI: 2.2 to 21.6) higher prevalence of disability than those with normal BMI. Conclusions: We found no evidence that weight improvement associated with ART use is likely to increase disability.
Antiretroviral Therapy Cohort. (2017). Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: A collaborative analysis of cohort studies. Lancet HIV, 4(8), e349-e356. doi:10.1016/S2352-3018(17)30066-8
2.
AsiimweS. B.MuzooraC.WilsonL. A.MooreC. C. (2015). Bedside measures of malnutrition and association with mortality in hospitalized adults. Clinical Nutrition, 34(2), 252-256. doi:10.1016/j.clnu.2014.03.013
3.
Avila-FunesJ. A.Belaunzarán-ZamudioP. F.Tamez-RiveraO.Crabtree-RamírezB.Navarrete-ReyesA. P.Cuellar-RodríguezJ.Sierra-MaderoJ.AmievaH. (2016). Correlates of prevalent disability among HIV-infected elderly patients. AIDS Research and Human Retroviruses, 32(2), 155-162. doi:10.1089/AID.2015.0171
4.
BaresS. H.SmeatonL. M.XuA.GodfreyC.McComseyG. A. (2018). HIV-infected women gain more weight than HIV-infected men following the Initiation of antiretroviral therapy. Journal of Women’s Health, 27(9), 1162-1169. doi:10.1089/jwh.2017.6717
5.
BernardC.DabisF.de RekeneireN. (2017). Physical function, grip strength and frailty in people living with HIV in sub-Saharan Africa: Systematic review. Tropical Medicine & International Health, 22(5), 516-525. doi:10.1111/tmi.12852
6.
ChariotP.Dubreuil-LemaireM.-L.ZhouJ. Y.LamiaB.DumeL.LarcherB.MonnetI.LevyY.AstierA.GherardiR. (1997). Muscle involvement in human immunodeficiency virus-infected patients is associated with marked selenium deficiency. Muscle & Nerve, 20(3), 386-389. doi:10.1002/(SICI)1097-4598(199703)20:3<386::AID-MUS23>3.0.CO;2-Y
7.
DunkleK. L.JewkesR. K.BrownH. C.GrayG. E.McIntryreJ. A.HarlowS. D. (2004). Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet, 363(9419), 1415-1421. doi:10.1016/S0140-6736(04)16098-4
8.
GeldsetzerP.FeiglA. B.TanserF.GaretaD.PillayD.BärnighausenT. (2017). Population-level decline in BMI and systolic blood pressure following mass HIV treatment: Evidence from rural KwaZulu-Natal. Obesity, 25(1), 200-206. doi:10.1002/oby.21663
9.
Gómez-OlivéF. X.MontanaL.WagnerR. G.KabudulaC. W.RohrJ. K.KahnK.BärnighausenT.CollinsonM.CanningD.GazianoT.SalomonJ. A.PayneC. F.WadeA.TollmanS. M.BerkmanL. (2018). Cohort Profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). International Journal of Epidemiology, 47(3), 689-690. doi:10.1093/ije/dyx247
10.
Hanass-HancockJ.MyezwaH.CarpenterB. (2015). Disability and living with HIV: Baseline from a cohort of people on long term ART in South Africa. PLoS One, 10(12), Article e0143936. doi:10.1371/journal.pone.0143936
11.
Hanass-HancockJ.MyezwaH.NixonS. A.GibbsA. (2015). “When I was no longer able to see and walk, that is when I was affected most”: Experiences of disability in people living with HIV in South Africa. Disability and Rehabilitation, 37(22), 2051-2060. doi:10.3109/09638288.2014
12.
HarlingG.PayneC. F.DaviesJ. I.Gomez-OliveF. X.KahnK.MandersonL.MateenF. J.TollmanS. M.WithamM. D. (2019). Impairment in activities of daily living, care receipt, and unmet needs in a middle-aged and older rural South African population: Findings from the HAALSI study. Journal of Aging and Health, 32(5-6). doi:10.1177/0898264318821220
13.
JiangM.ZouY.XinQ.CaiY.WangY.QinX.MaD. (2019). Dose-response relationship between body mass index and risks of all-cause mortality and disability among the elderly: A systematic review and meta-analysis. Clinical Nutrition, 38(4), 1511-1523. doi:10.1016/j.clnu.2018.07.021
14.
KakinamiL.de BruynG.PronykP.MohapiL.TshabanguN.MoshabelaM.McIntyreJ.MartinsonN. A. (2011). The impact of highly active antiretroviral therapy on activities of daily living in HIV-infected adults in South Africa. AIDS and Behavior, 15(4), 823-831. doi:10.1007/s10461-010-9776-y
15.
KobayashiL. C.GlymourM. M.KahnK.PayneC. F.WagnerR. G.MontanaL.MateenF. J.TollmanS. M.BerkmanL. F. (2017). Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans. Social Science & Medicine, 190, 20-28. doi:10.1016/j.socscimed.2017.08.009
16.
LimaV. D.HoggR. S.HarriganP. R.MooreD.YipB.WoodE.MontanerJ. S. G. (2007). Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS, 21(6), 685-692. doi:10.1097/QAD.0b013e32802ef30c
17.
Manne-GoehlerJ.MontanaL.Gómez-OlivéF. X.RohrJ.HarlingG.WagnerR. G.WadeA.KabudulaC. W.GeldsetzerP.KahnK.TollmanS.BerkmanL. F.BärnighausenT. W.GazianoT. A. (2017) The ART advantage. Journal of Acquired Immune Deficiency Syndromes, 75(5), 561-567. doi:10.1097/QAI0000000000001445
18.
Manne-GoehlerJ.RohrJ.MontanaL.SiednerM.HarlingG.Gómez-OlivéF. X.GeldsetzerP.WagnerR.WiesnerL.KahnK.TollmanS.BärnighausenT. W. (2018). ART denial: Results of a home-based study to validate self-reported antiretroviral use in rural South Africa. AIDS and Behavior, 23, 2072-2078. doi:10.1007/s10461-018-2351-7
19.
MyezwaH.Hanass-HancockJ.AjidahunA. T.CarpenterB. (2018). Disability and health outcomes—From a cohort of people on long-term anti-retroviral therapy. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 15(1), 50-59. doi:10.1080/17290376.2018.1459813
20.
MyezwaH.Hanass-HancockJ.PautzN. (2018). Investigating the interaction between human immunodeficiency virus, nutrition, and disability: A cross-sectional observational study. African Journal of Primary Health Care & Family Medicine, 10(1), e1-e8. doi:10.4102/phcfm.v10i1.1663
21.
NaidooK.Yende-ZumaN.AugustineS. (2018). A retrospective cohort study of body mass index and survival in HIV infected patients with and without TB co-infection. Infectious Diseases of Poverty, 7(1), Article 35. doi:10.1186/s40249-018-0418-3
22.
NyirendaM.ChatterjiS.FalkinghamJ.MutevedziP.HosegoodV.EvandrouM.KowalP.NewellM.-L. (2012). An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa. BMC Public Health, 12, Article 259. doi:10.1186/1471-2458-12-259
23.
OnenN. F.OvertonE. T. (2011). A review of premature frailty in HIV-infected persons; another manifestation of HIV-related accelerated aging. Current Aging Science, 4(1), 33-41.
24.
PayneC. F.Gómez-OlivéF. X.KahnK.BerkmanL. (2017). Physical function in an aging population in rural South Africa: Findings from HAALSI and cross-national comparisons with HRS sister studies. The Journals of Gerontology: Series B, 72(4), 665-679. doi:10.1093/geronb/gbx030
25.
PfefferbaumA.ZahrN. M.SassoonS. A.KwonD.PohlK. M.SullivanE. V. (2018). Accelerated and premature aging characterizing regional cortical volume loss in human immunodeficiency virus infection: Contributions from alcohol, substance use, and Hepatitis C coinfection. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(10), 844-859. doi:10.1016/j.bpsc.2018.06.006
26.
PlazyM.FaroukiK. E.IwujiC.OkesolaN.Orne-GliemannJ.LarmarangeJ.LertF.NewellM.-L.DabisF.Dray-SpiraR., & Anrs 12249 Tasp Study Group. (2016). Access to HIV care in the context of universal test and treat: Challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa. Journal of the International AIDS Society, 19(1), 20913. doi:10.7448/IAS.19.1.20913
27.
PriceA. J.CrampinA. C.AmberbirA.Kayuni-ChihanaN.MusichaC.TafatathaT.BransonK.LawlorD. A.MwaiyegheleE.NkhwaziL.SmeethL.PearceN.MunthaliE.MwagombaB. M.MwansamboC.GlynnJ. R.JaffarS.NyirendaM. (2018). Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: A cross-sectional, population-based study in rural and urban Malawi. The Lancet Diabetes & Endocrinology, 6(3), 208-222. doi:10.1016/S2213-8587(17)30432-1
28.
RothmanK. J. (2008). BMI-related errors in the measurement of obesity. International Journal of Obesity, 32, S56-S59. doi:10.1038/ijo.2008.87
29.
SmithR. L.de BoerR.BrulS.BudovskayaY.van der SpekH. (2012). Premature and accelerated aging: HIV or HAART?Frontiers in Genetics, 3, 328. doi:10.3389/fgene.2012.00328
30.
TomitaA.GarrettN.WernerL.BurnsJ. K.NgcoboN.ZumaN.MlisanaK.van LoggerenbergF.Abdool KarimS. S. (2014). Impact of antiretroviral therapy on health-related quality of life among South African women in the CAPRISA 002 acute infection study. AIDS and Behavior, 18(9), 1801-1807. doi:10.1007/s10461-014-0800-5
31.
WestreichD.GreenlandS. (2013). The Table 2 fallacy: Presenting and interpreting confounder and modifier coefficients. American Journal of Epidemiology, 177(4), 292-298.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
