Dietary practices, obesity and CD4 count among adults with HIV on antiretroviral therapy in Johannesburg, South Africa: a secondary cross- sectional analysis of the ADVANCE trial
In a secondary cross-sectional analysis of the ADVANCE trial, researchers found that while obesity was prevalent among adults with HIV on antiretroviral therapy in Johannesburg, assessed dietary practices were not independently associated with obesity or lower CD4 counts after adjusting for multiple comparisons.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, the global fight against HIV focused on a single, life-saving goal: keeping the virus suppressed so people could live long lives. Thanks to effective medication, that goal has been met for millions, shifting the medical landscape from managing a fatal disease to managing a chronic condition. But as people with HIV now live longer, a new challenge has emerged alongside the virus. Many are gaining significant weight, leading to obesity and related heart health issues. This shift has forced doctors and scientists to ask a difficult question: is the weight gain a side effect of the medication itself, or is it driven by the way people are eating? In South Africa, where the virus remains widespread and obesity is a growing public health crisis, understanding the link between daily food choices and body weight is critical for designing better care.
Researchers in Johannesburg recently took a deep dive into this question by looking at a large group of adults who had been taking HIV medication for many years. They wanted to see if specific eating habits—such as how often people ate fruit, fried foods, or traditional staples like pap, or whether they skipped meals—could explain why some participants had become obese while others had not. They also checked if these dietary habits were linked to the strength of the immune system, measured by a specific type of white blood cell count. The team analyzed data from 618 adults, examining their food diaries and health records collected over several years. The group was diverse, with a mix of men and women, and the average age was just under 34 years old. At the time of the study, more than a quarter of the participants were classified as obese, a rate that mirrors the broader trend seen among people with HIV in the region.
The scientists approached the data with a careful, methodical eye, treating the food records as snapshots of daily life rather than a complete history of every meal. They looked for patterns that might connect specific foods to weight gain or lower immune cell counts. They found that while some initial hints appeared, they did not hold up under closer scrutiny. For instance, a small number of people who reported following a "special diet" were more likely to be obese, but the researchers suspected this was not because the diet caused the weight. Instead, it was more likely that people who had already gained weight or developed health concerns turned to special diets in response. Similarly, those who ate fruit one to three times a week appeared to have lower odds of obesity compared to those who ate it less often, but this protective effect disappeared for those who ate fruit four or more times a week. This inconsistent pattern suggested that fruit consumption alone was not the deciding factor.
When the researchers adjusted their analysis to account for other factors like age, gender, employment, and the specific type of medication each person took, the connections between food and weight were not found to be independently associated with obesity or lower immune cell counts after correcting for multiple comparisons. The study concluded that the specific dietary practices assessed were not independently linked to these outcomes in this group. Even the type of medication played a role, with one specific drug combination showing a nominal link to lower obesity rates compared to another, but this difference was not strong enough to be considered a definitive finding after accounting for the many comparisons made. The same lack of clear connection held true for the immune system; no specific eating habit was reliably linked to having lower immune cell counts. The study concluded that while obesity is a serious and common issue for people on long-term HIV treatment, the simple food choices captured in this survey do not tell the whole story. The weight gain is likely the result of a complex mix of factors that go far beyond just what is on the plate, suggesting that future solutions will need to look at the broader picture of health, activity, and environment rather than focusing on single dietary items.
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