When obesity is desirable: A longitudinal study of the Miami HIV-1-infected drug abusers (MIDAS) cohort

Despite widespread nutrient deficiencies, a substantial proportion of the M IDAS cohort exhibits obesity, which has been linked to immune dysregulation in other clinical settings. Herein, the effects of obesity on immune funct ion, disease progression, and mortality were evaluated longitudinally in 12 5 HIV-1-seropositive drug users, with comparison measures in 148 HIV-1-sero negative controls. Data were collected at a community clinic from 1992 to 1 996, before administration of highly active antiretroviral therapy. Results indicated that overweight/obesity, defined as body mass index (BMI; kg/m(2 )) greater than or equal to 27, was evident in 18% of the HIV-1-seropositiv e patients and 29% of the seronegative patients. At baseline, no significan t immunologic differences were observed among lean, nonobese, and obese gro ups. Over an 18-month period, 60.5% of the nonobese HIV-1-seropositive pati ents exhibited a 25% decline in CD4 cell count, compared with 18% of the ob ese patients (p < .004). During the follow-up period, 38% of the lean and 1 3% of the nonobese study subjects died of HIV-1-related causes. Measurement s of BMI were inversely associated with progression to death, independent o f CD4 count <200 cells/mm(3) (p < .02). These data suggest that mild-to-mod erate obesity in HIV-1-infected chronic drug users does not impair immune f unction and is associated with better HIV-1-related survival.