Association between obesity and combination antiretroviral therapy (cART) adherence among persons with early-stage HIV infection initiating cART

Background Obesity is common among people living with HIV (PLWH) and early-stage infection, yet associations with combination antiretroviral (cART) adherence are unclear. Methods Among PLWH initiating cART in Uganda and South Africa, body mass index (BMI) was assessed at cART initiation, and cART adherence was monitored in real-time over 12 months. The association of obesity (BMI ≥ 30 kg/m 2 ) with adherence was assessed among nonpregnant participants with CD4 > 350 cells/mm 3 using fractional regression modeling. Results Among 322 participants, median age was 32 years, 70% were female, and 54% were from Uganda. Prevalence of obesity was 12% in Uganda and 28% in South Africa. Mean overall cART adherence was 83% in Uganda and 66% in South Africa. Participants with obesity had higher adherence than those without obesity: +3.6% ( p = 0.44) in Uganda and +11.4% ( p = 0.02) in South Africa. Conclusion Obesity at cART initiation was common and associated with higher adherence, although only significantly in South Africa.