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RANDOMIZED TRIAL OF BEHAVIORAL WEIGHT LOSS FOR HIV-INFECTED PATIENTS
Katie Becofsky1, Edward J. Wing2, Jeanne McCaffery3, Matthew Boudreau3, Rena R. Wing3
1Univ of Massachusetts Amherst, Amherst, MA, USA,2Brown Univ, Providence, RI, USA,3The Miriam Hosp, Providence, RI, USA
Obesity is increasingly prevalent in HIV-infected patients and compounds their cardiovascular disease (CVD) risk. Behavioral weight loss programs are recommended for overweight and obese individuals, but have not been systematically studied in people living with HIV. We conducted the first randomized trial testing the efficacy of an empirically validated behavioral weight loss program in HIV-infected patients.
40 overweight or obese HIV-infected patients (49.9± 8.8 years of age; BMI of 34.2±34.2), with an undetectable viral load and CD4 count >200 were randomly assigned to a fully-automated Internet-delivered behavioral Weight Loss program (WT LOSS) or Internet Education Control. The behavioral weight loss program includes 12 weekly video lessons, a platform to submit self-monitoring data, and automated feedback tailored to the individual. The primary outcome was weight loss over the 12-week program; secondary outcomes were health-related quality of life (HRQOL), use of weight control strategies, and CVD risk factors.
92% of participants completed the study. Average weight losses in intent-to-treat analyses were significantly greater for WT LOSS than Control (4.4 ± 5.4 kg vs 1.0±3.3 kg, p=.02). On average, participants viewed 7 lessons and submitted their data on 8 of the 12 weeks; both measures of adherence were strongly related to weight loss (r=.61 and .63, p<.01). Participants in WT LOSS reported greater increases in the use of weight control strategies than Controls; moreover, 59% of WT LOSS versus 21% of Controls reported improvements in HRQOL (p<.05). There were no significant differences between WT LOSS and Control on changes in CVD risk factors.
HIV-infected patients adhered to the behavioral weight loss program and, on average, lost 4.4 kg, which was similar to the outcomes previously reported using the same Internet program in non-HIV participants. HRQOL and use of healthy weight control strategies also improved. Thus, this population responded well to the program despite their low socioeconomic status (60% had income <$20,000), mental health comorbidities (67% had history of depression), and complex medical regimens (average 4.3 medications in addition to cART). This weight loss program is completely automated and can be easily disseminated. Further research on the efficacy of weight loss interventions for improving the health of HIV-infected patients is needed.