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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Weight status and associated factors among HIV-infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa</title><author><name sortKey="Mashinya, Felistas" sort="Mashinya, Felistas" uniqKey="Mashinya F" first="Felistas" last="Mashinya">Felistas Mashinya</name><affiliation><nlm:aff id="AF0001">Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo, South Africa</nlm:aff></affiliation></author><author><name sortKey="Alberts, Marianne" sort="Alberts, Marianne" uniqKey="Alberts M" first="Marianne" last="Alberts">Marianne Alberts</name><affiliation><nlm:aff id="AF0001">Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo, South Africa</nlm:aff></affiliation></author><author><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><affiliation><nlm:aff id="AF0002">Global Health Institute, Faculty of Medicine, Antwerp University, Belguim</nlm:aff></affiliation></author><author><name sortKey="Van Geertruyden, Jean Pierre" sort="Van Geertruyden, Jean Pierre" uniqKey="Van Geertruyden J" first="Jean-Pierre" last="Van Geertruyden">Jean-Pierre Van Geertruyden</name><affiliation><nlm:aff id="AF0002">Global Health Institute, Faculty of Medicine, Antwerp University, Belguim</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28155318</idno><idno type="pmc">5153409</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153409</idno><idno type="RBID">PMC:5153409</idno><idno type="doi">10.4102/phcfm.v8i1.1230</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002129</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002129</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Weight status and associated factors among HIV-infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa</title><author><name sortKey="Mashinya, Felistas" sort="Mashinya, Felistas" uniqKey="Mashinya F" first="Felistas" last="Mashinya">Felistas Mashinya</name><affiliation><nlm:aff id="AF0001">Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo, South Africa</nlm:aff></affiliation></author><author><name sortKey="Alberts, Marianne" sort="Alberts, Marianne" uniqKey="Alberts M" first="Marianne" last="Alberts">Marianne Alberts</name><affiliation><nlm:aff id="AF0001">Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo, South Africa</nlm:aff></affiliation></author><author><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><affiliation><nlm:aff id="AF0002">Global Health Institute, Faculty of Medicine, Antwerp University, Belguim</nlm:aff></affiliation></author><author><name sortKey="Van Geertruyden, Jean Pierre" sort="Van Geertruyden, Jean Pierre" uniqKey="Van Geertruyden J" first="Jean-Pierre" last="Van Geertruyden">Jean-Pierre Van Geertruyden</name><affiliation><nlm:aff id="AF0002">Global Health Institute, Faculty of Medicine, Antwerp University, Belguim</nlm:aff></affiliation></author></analytic><series><title level="j">African Journal of Primary Health Care & Family Medicine</title><idno type="ISSN">2071-2928</idno><idno type="eISSN">2071-2936</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>Underweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD).</p></sec><sec id="st2"><title>Aim</title><p>The study determined weight status and associated factors in people with HIV infection receiving ART.</p></sec><sec id="st3"><title>Setting</title><p>Rural primary health care clinics in Dikgale, Limpopo province, South Africa.</p></sec><sec id="st4"><title>Methods</title><p>A cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m<sup>2</sup>). Data on ART duration were extracted from patients’ files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques.</p></sec><sec id="st5"><title>Results</title><p>Of the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, <italic>p</italic> = 0.001) and male gender (OR: 0.29, <italic>p</italic> = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, <italic>p</italic> = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis.</p></sec><sec id="st6"><title>Conclusion</title><p>A high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Crum Ciaflone, N" uniqKey="Crum Ciaflone N">N Crum-Ciaflone</name></author><author><name sortKey="Roediger, Mp" uniqKey="Roediger M">MP Roediger</name></author><author><name sortKey="Eberly, L" uniqKey="Eberly L">L Eberly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cofrancesco J, Jr" uniqKey="Cofrancesco J J">Jr Cofrancesco J</name></author><author><name sortKey="Freedland, E" uniqKey="Freedland E">E Freedland</name></author><author><name sortKey="Mccomsey, G" uniqKey="Mccomsey G">G McComsey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, N" uniqKey="Li N">N 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Afr J Prim Health Care Fam Med</journal-id><journal-id journal-id-type="iso-abbrev">Afr J Prim Health Care Fam Med</journal-id><journal-id journal-id-type="publisher-id">PHCFM</journal-id><journal-title-group><journal-title>African Journal of Primary Health Care & Family Medicine</journal-title></journal-title-group><issn pub-type="ppub">2071-2928</issn><issn pub-type="epub">2071-2936</issn><publisher><publisher-name>AOSIS</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28155318</article-id><article-id pub-id-type="pmc">5153409</article-id><article-id pub-id-type="publisher-id">PHCFM-8-1230</article-id><article-id pub-id-type="doi">10.4102/phcfm.v8i1.1230</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Weight status and associated factors among HIV-infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Mashinya</surname><given-names>Felistas</given-names></name><xref ref-type="aff" rid="AF0001">1</xref></contrib><contrib contrib-type="author"><name><surname>Alberts</surname><given-names>Marianne</given-names></name><xref ref-type="aff" rid="AF0001">1</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-1919-1340</contrib-id><name><surname>Colebunders</surname><given-names>Robert</given-names></name><xref ref-type="aff" rid="AF0002">2</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-5006-6364</contrib-id><name><surname>Van Geertruyden</surname><given-names>Jean-Pierre</given-names></name><xref ref-type="aff" rid="AF0002">2</xref></contrib><aff id="AF0001"><label>1</label>Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo, South Africa</aff><aff id="AF0002"><label>2</label>Global Health Institute, Faculty of Medicine, Antwerp University, Belguim</aff></contrib-group><author-notes><corresp id="cor1"><bold>Corresponding to:</bold> Felistas Mashinya, <email xlink:href="felistas.mashinya@ul.ac.za">felistas.mashinya@ul.ac.za</email></corresp></author-notes><pub-date pub-type="epub"><day>29</day><month>11</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>8</volume><issue>1</issue><elocation-id>1230</elocation-id><history><date date-type="received"><day>14</day><month>6</month><year>2016</year></date><date date-type="accepted"><day>08</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>© 2016. The Authors</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>AOSIS. This work is licensed under the Creative Commons Attribution License.</license-p></license></permissions><abstract><sec id="st1"><title>Background</title><p>Underweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD).</p></sec><sec id="st2"><title>Aim</title><p>The study determined weight status and associated factors in people with HIV infection receiving ART.</p></sec><sec id="st3"><title>Setting</title><p>Rural primary health care clinics in Dikgale, Limpopo province, South Africa.</p></sec><sec id="st4"><title>Methods</title><p>A cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m<sup>2</sup>). Data on ART duration were extracted from patients’ files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques.</p></sec><sec id="st5"><title>Results</title><p>Of the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, <italic>p</italic> = 0.001) and male gender (OR: 0.29, <italic>p</italic> = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, <italic>p</italic> = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis.</p></sec><sec id="st6"><title>Conclusion</title><p>A high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.</p></sec></abstract></article-meta></front><body><sec id="s0001"><title>Background</title><p>Overweight is a growing public health problem among HIV-infected people on ART, as also observed in the general populations worldwide.<sup><xref rid="CIT0001" ref-type="bibr">1</xref></sup> The increase in weight among HIV-infected people on ART has been attributed to a state of return to health in which appetite is gained and more food consumed, coupled with low physical activity.<sup><xref rid="CIT0001" ref-type="bibr">1</xref></sup> Weight gain in people on ART has been characterized by dorsocervical fat pad and visceral fat accumulation that may increase the risk of coronary artery disease.<sup><xref rid="CIT0002" ref-type="bibr">2</xref></sup> However, the relatively high percentage of people on ART that are underweight is still a concern.<sup><xref rid="CIT0003" ref-type="bibr">3</xref></sup> Being overweight or underweight may increase the risk of cardiovascular diseases.<sup><xref rid="CIT0004" ref-type="bibr">4</xref>,<xref rid="CIT0005" ref-type="bibr">5</xref></sup></p><p>Although the developed world is faced with an increasing problem of overweight among HIV-infected people on ART,<sup><xref rid="CIT0006" ref-type="bibr">6</xref>,<xref rid="CIT0007" ref-type="bibr">7</xref></sup> the developing world is experiencing a double burden of underweight and overweight.<sup><xref rid="CIT0008" ref-type="bibr">8</xref>,<xref rid="CIT0009" ref-type="bibr">9</xref>,<xref rid="CIT0010" ref-type="bibr">10</xref></sup> However, the prevalence of underweight and overweight reported from African countries is different,<sup><xref rid="CIT0008" ref-type="bibr">8</xref>,<xref rid="CIT0009" ref-type="bibr">9</xref>,<xref rid="CIT0010" ref-type="bibr">10</xref></sup> possibly due to differences in ART regimen, duration of ART and socio-economic factors.<sup><xref rid="CIT0002" ref-type="bibr">2</xref></sup></p><p>Reports on the burden of underweight and overweight among HIV-infected people from rural parts of South Africa are limited. Up-to-date information on the distribution of weight status among HIV-infected people can guide health providers in designing and improving health promotion programmes. Our goals were (i) to determine the prevalence of underweight and overweight in persons with HIV infection on ART in a rural area in the Limpopo province, one of the poorest provinces in South Africa, and (ii) to identify factors associated with being underweight and overweight in the study population.</p></sec><sec id="s0002"><title>Methods</title><sec id="s20003"><title>Study design</title><p>The study was a descriptive cross-sectional study in which data were collected at one point in time. The study used quantitative methods that generated numerical data. Description of participants’ measurements and responses expressed as frequencies and categorised assisted in determining the factors associated with being underweight and overweight using regression models.</p></sec><sec id="s20004"><title>Setting</title><p>The study was conducted in the three primary health care clinics, Seobi-Dikgale, Sebayeng and Dikgale that are situated within the Dikgale Health and Demographic Surveillance System (HDSS) site. The Dikgale HDSS site consists of 15 villages and is situated about 70 kms to the northeast of Polokwane, the capital city of Limpopo province. Limpopo province is one of the poorest provinces and is situated in the northern part of South Africa.</p></sec><sec id="s20005"><title>Sample size calculation</title><p>The sample size was obtained using the formula for proportion in a cross-sectional study as <inline-formula id="FD0001"><alternatives><mml:math id="M1"><mml:mrow><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mfrac><mml:mstyle displaystyle="true" scriptlevel="0"><mml:mrow><mml:msup><mml:mrow><mml:mi>z</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup><mml:mi>p</mml:mi><mml:mrow><mml:mo>(</mml:mo><mml:mn>1</mml:mn><mml:mo>–</mml:mo><mml:mi>p</mml:mi><mml:mo>)</mml:mo></mml:mrow></mml:mrow></mml:mstyle><mml:mstyle displaystyle="true" scriptlevel="0"><mml:mrow><mml:msup><mml:mrow><mml:mi>d</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup></mml:mrow></mml:mstyle></mml:mfrac></mml:mrow></mml:math><graphic xlink:href="PHCFM-8-1230-i001.jpg" position="float" orientation="portrait"></graphic></alternatives></inline-formula> where <italic>n</italic> = sample size, <italic>Z</italic> = a statistic for 95% confidence interval is 1.96, <italic>P</italic> = expected proportion, <italic>d</italic> = the maximum permissible difference between sample proportion and population proportion calculated as 20/100 x <italic>P</italic>.<sup><xref rid="CIT0011" ref-type="bibr">11</xref></sup></p><p>According to literature, the proportion of overweight in ARV-treated Africans ranges from 27.9% to 46.0%.<sup><xref rid="CIT0009" ref-type="bibr">9</xref>,<xref rid="CIT0010" ref-type="bibr">10</xref></sup> Considering an average proportion of 36%, and a corresponding maximum margin of error of 7%, sample size was calculated as follows: Sample size <inline-formula id="FD0002"><alternatives><mml:math id="M2"><mml:mrow><mml:mo>=</mml:mo><mml:mfrac><mml:mstyle displaystyle="true" scriptlevel="0"><mml:mrow><mml:mrow><mml:mo>(</mml:mo><mml:mn>1.96</mml:mn><mml:msup><mml:mrow><mml:mo>)</mml:mo></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup><mml:mn>0.36</mml:mn><mml:mrow><mml:mo>(</mml:mo><mml:mn>1</mml:mn><mml:mo>–</mml:mo><mml:mn>0.36</mml:mn><mml:mo>)</mml:mo></mml:mrow></mml:mrow></mml:mrow></mml:mstyle><mml:mstyle displaystyle="true" scriptlevel="0"><mml:mrow><mml:mrow><mml:mo>(</mml:mo><mml:mn>0.07</mml:mn><mml:msup><mml:mrow><mml:mo>)</mml:mo></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup></mml:mrow></mml:mrow></mml:mstyle></mml:mfrac><mml:mo>=</mml:mo><mml:mn>181</mml:mn></mml:mrow></mml:math><graphic xlink:href="PHCFM-8-1230-i002.jpg" position="float" orientation="portrait"></graphic></alternatives></inline-formula> people</p><p>A 10% allowance was considered and the expected sample size was 200 people.</p></sec><sec id="s20006"><title>Study population and sampling</title><p>The study population comprised of approximately 74 people with HIV infection treated at Seobi-Dikgale clinic, 373 people at Sebayeng and 377 people at Dikgale clinic. Based on these databases and using convenient sampling method, 20 people were recruited from Seobi-Dikgale, 96 people from Sebayeng and 98 from Dikgale clinics. A total of 214 participants were included in the study, and one was excluded due to pregnancy.</p><p>Participants aged 15 years and above who came to collect their ART were asked to participate in the study and were only included after written informed consent was obtained through the completion of a consent form approved by the MEDUNSA Ethics committee (-MREC/HS/137/2011:PG). In the case of minors, written informed consent was obtained from their legal guardians. Pregnant women were excluded.</p></sec><sec id="s20007"><title>Data collection</title><p>Recruitment and clinical assessment were conducted from September 2013 to March 2014. The WHO stepwise approach to surveillance (STEPS) questionnaire<sup><xref rid="CIT0012" ref-type="bibr">12</xref></sup> was used to obtain information on socio-demographic characteristics, fruit and vegetable intake, physical activity, tobacco use and alcohol consumption. The questionnaire was first used on few people who did not form part of the study. Physical activity and fruit and vegetable intake levels were calculated using WHO analysis programmes guide.<sup><xref rid="CIT0013" ref-type="bibr">13</xref></sup> Physical inactivity was defined as < 600 metabolic equivalent task-minutes/week (MET-minutes/week), and low fruit and vegetable intake was defined as < 5 servings/day.<sup><xref rid="CIT0013" ref-type="bibr">13</xref></sup> Data on ART duration were extracted from patients’ files.</p></sec><sec id="s20008"><title>Anthropometric measurements</title><p>Anthropometric measurements were taken following procedures as previously described.<sup><xref rid="CIT0014" ref-type="bibr">14</xref></sup> In brief, weight was measured to the nearest 0.1 kg, using Omron BF 400 (Omron Healthcare, Japan). Height was measured to the nearest 0.1 cm, using a stadiometer. Body mass index (BMI) was calculated as weight (kg)/height (m<sup>2</sup>). BMI is considered as underweight (< 18.5 kg/m<sup>2</sup>), normal (18.5–24.9 kg/m<sup>2</sup>), overweight (25.0–29.9 kg/m<sup>2</sup>) and obese (≥ 30.0 kg/m<sup>2</sup>).<sup>15</sup> However, in this study, a BMI of 25.00 kg/m<sup>2</sup> and above was considered overweight.</p></sec><sec id="s20009"><title>Blood collection</title><p>Fasting venous blood samples were drawn by registered nurses. Whole blood was used to measure CD4 counts on the day of collection. Plasma from whole blood was separated through centrifugation at 2000 rpm for 15 minutes and stored at –80<sup>°</sup>C until viral load determination.</p></sec><sec id="s20010"><title>Laboratory analysis</title><p>CD4 lymphocyte count was measured using the Pima Analyser (Inverness Medical, Tokyo, Japan). Viral load determination using the branched deoxyribonucleic acid (DNA) technique (Siemens, South Africa), was performed by Toga Molecular Biology and Pathology Medical Laboratory in South Africa.</p></sec><sec id="s20011"><title>Statistical analysis</title><p>Statistical analysis was performed using Statistical Package for Social Sciences version 23.<sup><xref rid="CIT0016" ref-type="bibr">16</xref></sup> Variables were tested for normality using frequency histograms and line graphs. Data not normally distributed were logarithmically transformed for analysis. ANOVA was used to compare continuous variables and the chi-square test to compare categorical variables among underweight, normal weight and overweight groups. Bivariate logistic regression was used to determine individual influence of socio-demographic factors, HIV and ART variables on underweight and overweight status. Multivariate logistic regression modelling using a forward and backward stepwise approach was used to fit best predictive model and determine independent predictors. Factors significant at <italic>p</italic> ≤ 0.25 in univariate regression analysis and significant interaction terms at <italic>p</italic> < 0.05 were included in multivariate modelling.</p></sec><sec id="s20012"><title>Ethical considerations</title><p>Ethical approval was obtained from the Ethics Committee of University of Limpopo, Medunsa campus (MREC/HS/137/2011: PG). Permission to conduct the study in the Dikgale HDSS clinics was obtained from the Department of Health-Provincial office and Primary Health Care Capricorn District office.</p></sec></sec><sec id="s0013"><title>Results</title><sec id="s20014"><title>Socio-demographic and lifestyle characteristics of participants</title><p>Of the 214 participants on ART, the majority were women (171 [79.9%]). The mean age of participants was 44.8 ± 11.8 years. Based on BMI, a few participants (19 [8.9%]) were underweight; 117 (54.7%) had a normal weight; and 78 (36.4%) were overweight. Underweight was three times more prevalent in men (18.6%) than in women (6.4%), whereas overweight was twice as prevalent in women (40.9%) than in men (18.6%). The prevalence of underweight among tobacco users was double the prevalence among non-tobacco users (15.6% vs. 7.1%), whereas the prevalence of overweight was higher among non-tobacco users compared with tobacco users (39.6% vs. 24.4%). However, the differences were not significant. A significantly higher proportion of physically inactive (< 600MET-minute/week) than physically active (< 600MET-minute/week) people were overweight (100% vs. 16%, <italic>p</italic> < 0.05). None of the people whose daily intake was more than 5 servings/day of fruits and vegetables were underweight (<xref ref-type="table" rid="T0001">Table 1</xref>).</p><table-wrap id="T0001" orientation="portrait" position="float"><label>TABLE 1</label><caption><p>Socio-demographic and lifestyle variables among HIV-infected people on ART by weight status.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Socio-demographic variable</th><th valign="top" align="center" rowspan="1" colspan="1">All participants<break></break><italic>N</italic> = 214</th><th valign="top" align="center" colspan="3" rowspan="1">Weight status<hr></hr></th><th valign="top" align="center" rowspan="1" colspan="1">Linear association<break></break><italic>p</italic></th></tr><tr><th valign="top" align="left" rowspan="1" colspan="1"> </th><th valign="top" align="left" rowspan="1" colspan="1"> </th><th valign="top" align="center" rowspan="1" colspan="1">Underweight<break></break><italic>N</italic> = 19</th><th valign="top" align="center" rowspan="1" colspan="1">Normal weight<break></break><italic>N</italic> = 117</th><th valign="top" align="center" rowspan="1" colspan="1">Overweight<break></break><italic>N</italic> = 78</th><th valign="top" align="left" rowspan="1" colspan="1"> </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (years ± s.d.)</td><td align="left" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">47.67 ± 14.22</td><td align="center" rowspan="1" colspan="1">44.23 ± 11.96</td><td align="center" rowspan="1" colspan="1">44.87 ± 10.60</td><td align="center" rowspan="1" colspan="1">0.51<xref ref-type="table-fn" rid="TFN0001">*</xref></td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Age (years)</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> < 30</td><td align="center" rowspan="1" colspan="1">11 (5.1)</td><td align="center" rowspan="1" colspan="1">1 (9.1)</td><td align="center" rowspan="1" colspan="1">6 (54.5)</td><td align="center" rowspan="1" colspan="1">4 (36.4)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 30–39</td><td align="center" rowspan="1" colspan="1">69 (32.2)</td><td align="center" rowspan="1" colspan="1">4 (5.8)</td><td align="center" rowspan="1" colspan="1">43 (62.3)</td><td align="center" rowspan="1" colspan="1">22 (31.9)</td><td align="center" rowspan="1" colspan="1">0.88</td></tr><tr><td align="left" rowspan="1" colspan="1"> 40–49</td><td align="center" rowspan="1" colspan="1">64 (29.9)</td><td align="center" rowspan="1" colspan="1">6 (9.4)</td><td align="center" rowspan="1" colspan="1">31 (48.4)</td><td align="center" rowspan="1" colspan="1">27 (42.2)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> ≥ 50</td><td align="center" rowspan="1" colspan="1">70 (32.7)</td><td align="center" rowspan="1" colspan="1">8(11.4)</td><td align="center" rowspan="1" colspan="1">37 (52.9)</td><td align="center" rowspan="1" colspan="1">25 (35.7)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Gender</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">171 (79.9)</td><td align="center" rowspan="1" colspan="1">11 (6.4)</td><td align="center" rowspan="1" colspan="1">90 (52.6)</td><td align="center" rowspan="1" colspan="1">70 (40.9)</td><td align="center" rowspan="1" colspan="1">0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">43 (20.1)</td><td align="center" rowspan="1" colspan="1">8 (18.6)</td><td align="center" rowspan="1" colspan="1">27 (62.8)</td><td align="center" rowspan="1" colspan="1">8 (18.6)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Marital status</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Unmarried</td><td align="center" rowspan="1" colspan="1">164 (76.6)</td><td align="center" rowspan="1" colspan="1">15 (9.1)</td><td align="center" rowspan="1" colspan="1">90 (54.9)</td><td align="center" rowspan="1" colspan="1">59 (36.0)</td><td align="center" rowspan="1" colspan="1">0.75</td></tr><tr><td align="left" rowspan="1" colspan="1"> Married</td><td align="center" rowspan="1" colspan="1">50 (23.4)</td><td align="center" rowspan="1" colspan="1">4 (8.0)</td><td align="center" rowspan="1" colspan="1">27 (54.0)</td><td align="center" rowspan="1" colspan="1">19 (38.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Education</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Primary only</td><td align="center" rowspan="1" colspan="1">114 (53.3)</td><td align="center" rowspan="1" colspan="1">11 (9.6)</td><td align="center" rowspan="1" colspan="1">61 (53.5)</td><td align="center" rowspan="1" colspan="1">42 (36.8)</td><td align="center" rowspan="1" colspan="1">0.92</td></tr><tr><td align="left" rowspan="1" colspan="1"> Secondary and above</td><td align="center" rowspan="1" colspan="1">100 (46.7)</td><td align="center" rowspan="1" colspan="1">8 (8.0)</td><td align="center" rowspan="1" colspan="1">56 (56.0)</td><td align="center" rowspan="1" colspan="1">36 (36.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Employment</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Unemployed</td><td align="center" rowspan="1" colspan="1">166 (77.6)</td><td align="center" rowspan="1" colspan="1">17 (10.2)</td><td align="center" rowspan="1" colspan="1">87 (52.4</td><td align="center" rowspan="1" colspan="1">62 (37.3)</td><td align="center" rowspan="1" colspan="1">0.84</td></tr><tr><td align="left" rowspan="1" colspan="1"> Employed</td><td align="center" rowspan="1" colspan="1">48 (22.4)</td><td align="center" rowspan="1" colspan="1">2 (4.2)</td><td align="center" rowspan="1" colspan="1">30 (62.5)</td><td align="center" rowspan="1" colspan="1">16 (33.3)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Tobacco use</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">45 (21.0)</td><td align="center" rowspan="1" colspan="1">7 (15.6)</td><td align="center" rowspan="1" colspan="1">27 (60.0)</td><td align="center" rowspan="1" colspan="1">11 (24.4)</td><td align="center" rowspan="1" colspan="1">0.02</td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">169 (79.0)</td><td align="center" rowspan="1" colspan="1">12 (7.1)</td><td align="center" rowspan="1" colspan="1">90 (53.3)</td><td align="center" rowspan="1" colspan="1">67 (39.6)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Alcohol use</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">47 (22.0)</td><td align="center" rowspan="1" colspan="1">4 (8.5)</td><td align="center" rowspan="1" colspan="1">29 (61.7)</td><td align="center" rowspan="1" colspan="1">14 (29.8)</td><td align="center" rowspan="1" colspan="1">0.42</td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">167 (78.0)</td><td align="center" rowspan="1" colspan="1">15 (9.0)</td><td align="center" rowspan="1" colspan="1">88 (52.7)</td><td align="center" rowspan="1" colspan="1">64 (38.3)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Pima Analyser (PA)</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> < 600 MET-minutes/week</td><td align="center" rowspan="1" colspan="1">38 (24.2)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">38 (100)</td><td align="center" rowspan="1" colspan="1">0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> > 600 MET-minutes/week</td><td align="center" rowspan="1" colspan="1">119 (75.8)</td><td align="center" rowspan="1" colspan="1">14 (11.8)</td><td align="center" rowspan="1" colspan="1">86 (72.2)</td><td align="center" rowspan="1" colspan="1">19 (16.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Fruit and vegetable intake</th><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> < 5 servings/day</td><td align="center" rowspan="1" colspan="1">150 (95.5)</td><td align="center" rowspan="1" colspan="1">14 (9.3)</td><td align="center" rowspan="1" colspan="1">83 (55.3)</td><td align="center" rowspan="1" colspan="1">53 (35.3)</td><td align="center" rowspan="1" colspan="1">0.19</td></tr><tr><td align="left" rowspan="1" colspan="1"> > 5 servings/day</td><td align="center" rowspan="1" colspan="1">7 (4.5)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">3 (42.9)</td><td align="center" rowspan="1" colspan="1">4 (57.1)</td><td align="center" rowspan="1" colspan="1">-</td></tr></tbody></table><table-wrap-foot><fn><p>Data is presented as <italic>n</italic>(%) number (percentage) unless indicated.</p></fn><fn id="TFN0001"><label>*</label><p>Analysis of variance test (ANOVA) <italic>p</italic>-value and chi-square test were used to obtain linear association <italic>p</italic>-value; s.d., standard deviation; ART, antiretroviral therapy; MET-minute/week, metabolic equivalent of task-minutes/week. BMI was considered as underweight (< 18.5 kg/m<sup>2</sup>), normal (18.5–24.9 kg/m<sup>2</sup>) and overweight (≥ 25.0 kg/m<sup>2</sup>). Data for Pima Analyser (PA) and fruit and vegetable are available for 157 participants.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s20015"><title>Clinical characteristics of participants</title><p>The majority of participants were on efavirenz-based ART (86%) and nevirapine-based ART (12.5%). Only three of the participants (1.5%) were on a lopinavir or ritonavir-based ART regimen. The mean duration of ART in this study was 36 months (range: 1–121 months). Majority of the participants (85%) had an undetectable viral load, and the mean CD4 count was 462 ± 235 cells/mm<sup><xref rid="CIT0003" ref-type="bibr">3</xref></sup>.</p><p>The prevalence of underweight was lower in people with suppressed viral load (< 50 copies/ml) compared with people with a viral load of greater than 5000 copies/ml (7.3% vs. 20.0%, <italic>p</italic> > 0.05), whereas the prevalence of overweight was significantly higher in people with suppressed viral load (< 50 copies/ml) compared with people with a viral load of greater than 5000 copies/ml (39.9% vs. 0%, <italic>p</italic> < 0.05). Overweight people tended to have a higher mean CD4 count than the normal weight or underweight people, but levels of significance were not achieved. The levels of high sensitivity C-reactive protein were similarly high in underweight and in overweight people (7.01 mg/l vs. 5.75 mg/l, <italic>p</italic> > 0.05) but were significantly higher when compared with the levels in people with normal weight (<xref ref-type="table" rid="T0002">Table 2</xref>).</p><table-wrap id="T0002" orientation="portrait" position="float"><label>TABLE 2</label><caption><p>Clinical variables and conditions among HIV-infected people on ART by weight status.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Characteristics</th><th valign="top" align="center" rowspan="1" colspan="1">All participants<break></break><italic>N</italic> = 214</th><th valign="top" align="center" colspan="3" rowspan="1">Weight status<hr></hr></th><th valign="top" align="center" rowspan="1" colspan="1">Linear association<break></break><italic>p</italic></th></tr><tr><th valign="top" align="left" rowspan="1" colspan="1"> </th><th valign="top" align="left" rowspan="1" colspan="1"> </th><th valign="top" align="center" rowspan="1" colspan="1">Underweight<break></break><italic>N</italic> = 19</th><th valign="top" align="center" rowspan="1" colspan="1">Normal weight<break></break><italic>N</italic> = 117</th><th valign="top" align="center" rowspan="1" colspan="1">Overweight<break></break><italic>N</italic> = 78</th><th valign="top" align="left" rowspan="1" colspan="1"> </th></tr></thead><tbody><tr><td align="left" colspan="6" rowspan="1">HIV and ART variables</td></tr><tr><td align="left" rowspan="1" colspan="1">CD4 count (mean ± SD)</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">428.6 ± 255.6</td><td align="center" rowspan="1" colspan="1">432.7 ± 226.5</td><td align="center" rowspan="1" colspan="1">512.1 ± 237.1</td><td align="center" rowspan="1" colspan="1">0.06<xref ref-type="table-fn" rid="TFN0002">*</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Cell/mm<sup>3</sup></td><td align="center" rowspan="1" colspan="1">73 (35.4)</td><td align="center" rowspan="1" colspan="1">5 (6.8)</td><td align="center" rowspan="1" colspan="1">31 (42.5)</td><td align="center" rowspan="1" colspan="1">37 (50.7)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">> 500</td><td align="center" rowspan="1" colspan="1">61 (29.6)</td><td align="center" rowspan="1" colspan="1">5 (8.2)</td><td align="center" rowspan="1" colspan="1">39 (63.9)</td><td align="center" rowspan="1" colspan="1">17 (27.9)</td><td align="center" rowspan="1" colspan="1">0.01</td></tr><tr><td align="left" rowspan="1" colspan="1">351–500</td><td align="center" rowspan="1" colspan="1">54 (26.2)</td><td align="center" rowspan="1" colspan="1">7 (13.0)</td><td align="center" rowspan="1" colspan="1">27 (50.0)</td><td align="center" rowspan="1" colspan="1">20 (37.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">200–350</td><td align="center" rowspan="1" colspan="1">18 (8.7)</td><td align="center" rowspan="1" colspan="1">2 (11.1)</td><td align="center" rowspan="1" colspan="1">13 (72.2)</td><td align="center" rowspan="1" colspan="1">3 (16.7)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">< 200</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Viral load ( copies/ml)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> < 50</td><td align="center" rowspan="1" colspan="1">178 (83.2)</td><td align="center" rowspan="1" colspan="1">13 (7.3)</td><td align="center" rowspan="1" colspan="1">94 (52.8)</td><td align="center" rowspan="1" colspan="1">71 (39.9)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 51–500</td><td align="center" rowspan="1" colspan="1">15 (7.0)</td><td align="center" rowspan="1" colspan="1">3 (20.0)</td><td align="center" rowspan="1" colspan="1">9 (60.0)</td><td align="center" rowspan="1" colspan="1">3 (20.0)</td><td align="center" rowspan="1" colspan="1">0.008</td></tr><tr><td align="left" rowspan="1" colspan="1"> 501–5000</td><td align="center" rowspan="1" colspan="1">11 (5.1)</td><td align="center" rowspan="1" colspan="1">1 (9.1)</td><td align="center" rowspan="1" colspan="1">6 (54.5)</td><td align="center" rowspan="1" colspan="1">4 (36.4)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> > 5000</td><td align="center" rowspan="1" colspan="1">10 (4.7)</td><td align="center" rowspan="1" colspan="1">2 (20.0)</td><td align="center" rowspan="1" colspan="1">8 (80.0)</td><td align="center" rowspan="1" colspan="1">0 (0.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">ART duration (mean ± SD)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">38.35 ± 25.71</td><td align="center" rowspan="1" colspan="1">33.76 ± 24.59</td><td align="center" rowspan="1" colspan="1">39.07 ± 23.77</td><td align="center" rowspan="1" colspan="1">0.30<xref ref-type="table-fn" rid="TFN0002">*</xref></td></tr><tr><td align="left" rowspan="1" colspan="1"> > 60 months</td><td align="center" rowspan="1" colspan="1">34 (17.3)</td><td align="center" rowspan="1" colspan="1">4 (11.8)</td><td align="center" rowspan="1" colspan="1">18 (52.9)</td><td align="center" rowspan="1" colspan="1">12 (35.3)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 30–60 months</td><td align="center" rowspan="1" colspan="1">69 (35.2)</td><td align="center" rowspan="1" colspan="1">6 (8.7)</td><td align="center" rowspan="1" colspan="1">29 (42.0)</td><td align="center" rowspan="1" colspan="1">34 (49.3)</td><td align="center" rowspan="1" colspan="1">0.39</td></tr><tr><td align="left" rowspan="1" colspan="1"> < 30 months</td><td align="center" rowspan="1" colspan="1">93 (47.4)</td><td align="center" rowspan="1" colspan="1">7 (7.5)</td><td align="center" rowspan="1" colspan="1">60 (64.5)</td><td align="center" rowspan="1" colspan="1">26 (28.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">ART</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> EFV-based ART</td><td align="center" rowspan="1" colspan="1">172 (86)</td><td align="center" rowspan="1" colspan="1">17 (9.9)</td><td align="center" rowspan="1" colspan="1">93 (54.1)</td><td align="center" rowspan="1" colspan="1">62 (36.0)</td><td align="center" rowspan="1" colspan="1">0.35</td></tr><tr><td align="left" rowspan="1" colspan="1"> NVP-based ART</td><td align="center" rowspan="1" colspan="1">25 (12.5)</td><td align="center" rowspan="1" colspan="1">0(0.0)</td><td align="center" rowspan="1" colspan="1">15 (60.0)</td><td align="center" rowspan="1" colspan="1">10 (40.0)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Alluvia-based ART</td><td align="center" rowspan="1" colspan="1">3 (1.5)</td><td align="center" rowspan="1" colspan="1">1 (33.3)</td><td align="center" rowspan="1" colspan="1">0(0.0)</td><td align="center" rowspan="1" colspan="1">2 (66.7)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" colspan="6" rowspan="1">Clinical measurements and conditions</td></tr><tr><td align="left" colspan="6" rowspan="1">Diabetes</td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">10 (4.7)</td><td align="center" rowspan="1" colspan="1">1 (10.0)</td><td align="center" rowspan="1" colspan="1">5 (50.0)</td><td align="center" rowspan="1" colspan="1">4 (40.0)</td><td align="center" rowspan="1" colspan="1">0.90</td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">203 (95.3)</td><td align="center" rowspan="1" colspan="1">18 (8.9)</td><td align="center" rowspan="1" colspan="1">111 (54.7)</td><td align="center" rowspan="1" colspan="1">74 (36.5)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" colspan="6" rowspan="1">Hypertension</td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">56 (26.2)</td><td align="center" rowspan="1" colspan="1">3 (5.4)</td><td align="center" rowspan="1" colspan="1">27 (48.2)</td><td align="center" rowspan="1" colspan="1">26 (46.4)</td><td align="center" rowspan="1" colspan="1">0.06</td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">158 (73.8)</td><td align="center" rowspan="1" colspan="1">16 (10.1)</td><td align="center" rowspan="1" colspan="1">90 (57.0)</td><td align="center" rowspan="1" colspan="1">52 (32.9)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" colspan="6" rowspan="1">HsCRP</td></tr><tr><td align="left" rowspan="1" colspan="1"> Normal level</td><td align="center" rowspan="1" colspan="1">71 (34.8)</td><td align="center" rowspan="1" colspan="1">3 (4.2)</td><td align="center" rowspan="1" colspan="1">52 (73.2)</td><td align="center" rowspan="1" colspan="1">16 (22.5)</td><td align="center" rowspan="1" colspan="1">0.046</td></tr><tr><td align="left" rowspan="1" colspan="1"> High level</td><td align="center" rowspan="1" colspan="1">133 (65.2)</td><td align="center" rowspan="1" colspan="1">13 (9.8)</td><td align="center" rowspan="1" colspan="1">59 (44.4)</td><td align="center" rowspan="1" colspan="1">61 (45.9)</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" colspan="6" rowspan="1">HsCRP: (mg/l)</td></tr><tr><td align="left" rowspan="1" colspan="1">median(interquartile range)</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">7.01(3.22–15.6)</td><td align="center" rowspan="1" colspan="1">3.38(1.42–7.02)<sup>b</sup></td><td align="center" rowspan="1" colspan="1">5.75(3.34–11.1)<sup>b</sup></td><td align="center" rowspan="1" colspan="1">0.003<xref ref-type="table-fn" rid="TFN0002">*</xref></td></tr></tbody></table><table-wrap-foot><fn id="TFN0002"><label>*</label><p>Analysis of variance test (ANOVA) <italic>p</italic>-value and chi-square test were used to obtain linear association <italic>p</italic>-value. <sup>b</sup>, Indicates significantly different cells. Data are presented as <italic>n</italic>(%) - number (percentage) unless indicated. ART, antiretroviral therapy; BMI, body mass index; BMI was considered as underweight (< 18.5 kg/m<sup>2</sup>), normal (18.5–24.9 kg/m<sup>2</sup>) and overweight (≥ 25.0 kg/m<sup>2</sup>); HsCRP, high sensitivity C-reactive protein; NVP, nevirapine; EFV, efavirenz.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s20016"><title>Predictors of underweight in people on ART</title><p>In univariate analysis, gender (OR: 3.33, <italic>p</italic> = 0.02) and the interaction of gender and tobacco use (OR: 7.72, <italic>p</italic> = 0.001) were significantly associated with underweight. After controlling for employment, tobacco, fruit and vegetable intake, and viral load in multivariate model, the interaction of gender and tobacco use (OR: 10.87, <italic>p</italic> = 0.003) was an independent predictor of underweight in the final model (<xref ref-type="table" rid="T0003">Table 3</xref>).</p><table-wrap id="T0003" orientation="portrait" position="float"><label>TABLE 3</label><caption><p>Multivariate logistic regression analysis: predictors of underweight and overweight in HIV-infected people on ART.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Variables</th><th valign="top" align="center" colspan="4" rowspan="1">Underweight<hr></hr></th><th valign="top" align="center" colspan="4" rowspan="1">Overweight<hr></hr></th></tr><tr><th valign="top" align="left" rowspan="1" colspan="1"> </th><th valign="top" align="left" colspan="2" rowspan="1">Univariate<hr></hr></th><th valign="top" align="center" colspan="2" rowspan="1">Multivariate<hr></hr></th><th valign="top" align="center" colspan="2" rowspan="1">Univariate<hr></hr></th><th valign="top" align="center" colspan="2" rowspan="1">Multivariate<hr></hr></th></tr><tr><th valign="top" align="left" rowspan="1" colspan="1"> </th><th valign="top" align="left" rowspan="1" colspan="1">Crude OR (95% CI)</th><th valign="top" align="center" rowspan="1" colspan="1"><italic>p</italic></th><th valign="top" align="center" rowspan="1" colspan="1">AOR (95% CI)</th><th valign="top" align="center" rowspan="1" colspan="1"><italic>p</italic></th><th valign="top" align="center" rowspan="1" colspan="1">Crude OR (95%CI)</th><th valign="top" align="center" rowspan="1" colspan="1"><italic>p</italic></th><th valign="top" align="center" rowspan="1" colspan="1">AOR (95% CI)</th><th valign="top" align="center" rowspan="1" colspan="1"><italic>p</italic></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (years)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> < 30</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 30–39</td><td align="center" rowspan="1" colspan="1">0.68 (0.06–6.08)</td><td align="center" rowspan="1" colspan="1">0.68</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.82 (0.22–3.09)</td><td align="center" rowspan="1" colspan="1">0.77</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 40–49</td><td align="center" rowspan="1" colspan="1">1.03(0.11–9.53)</td><td align="center" rowspan="1" colspan="1">0.98</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1.28 (0.34–4.80)</td><td align="center" rowspan="1" colspan="1">0.72</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> ≥ 50</td><td align="center" rowspan="1" colspan="1">1.29 (0.15–11.5)</td><td align="center" rowspan="1" colspan="1">0.82</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.97 (0.26–3.65)</td><td align="center" rowspan="1" colspan="1">0.97</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Gender</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">3.33 (1.25 - 8.87)</td><td align="center" rowspan="1" colspan="1">0.02</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.33 (0.14–0.75)</td><td align="center" rowspan="1" colspan="1">0.009</td><td align="center" rowspan="1" colspan="1">0.29(0.09–0.97)</td><td align="center" rowspan="1" colspan="1">0.04</td></tr><tr><td align="left" rowspan="1" colspan="1">Marital status</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Unmarried</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1[Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Married</td><td align="center" rowspan="1" colspan="1">0.86 (0.27–2.73)</td><td align="center" rowspan="1" colspan="1">0.80</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1.09 (0.57–2.10)</td><td align="center" rowspan="1" colspan="1">0.95</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Education</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Primary</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1[Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Secondary and above</td><td align="center" rowspan="1" colspan="1">0.81 (0.31–2.11)</td><td align="center" rowspan="1" colspan="1">0.67</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.96 (0.55–1.69)</td><td align="center" rowspan="1" colspan="1">0.90</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Employment</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Unemployed</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Employed</td><td align="center" rowspan="1" colspan="1">0.62 (0.29–1.31)</td><td align="center" rowspan="1" colspan="1">0.21</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.84 (0.43–1.65)</td><td align="center" rowspan="1" colspan="1">0.61</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Tobacco use</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">2.41 (0.89 – 6.53)</td><td align="center" rowspan="1" colspan="1">0.08</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.49 (0.23–1.04)</td><td align="center" rowspan="1" colspan="1">0.06<xref ref-type="table-fn" rid="TFN0003">*</xref></td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Alcohol use</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1[ Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">0.94 (0.30–2.99)</td><td align="center" rowspan="1" colspan="1">0.92</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.68 (0.34–1.37)</td><td align="center" rowspan="1" colspan="1">0.28</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Physical activity</td><td align="center" rowspan="1" colspan="1">(1.00–1.00)</td><td align="center" rowspan="1" colspan="1">0.26</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.99 (0.98–1.00)</td><td align="center" rowspan="1" colspan="1">0.001<xref ref-type="table-fn" rid="TFN0003">*</xref></td><td align="center" rowspan="1" colspan="1">0.99 (0.99–1.00)</td><td align="center" rowspan="1" colspan="1">0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Fruit and vegetable intake</td><td align="center" rowspan="1" colspan="1">0.69 (0.37–1.29)</td><td align="center" rowspan="1" colspan="1">0.25<xref ref-type="table-fn" rid="TFN0003">*</xref></td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1.11 (0.89–1.39)</td><td align="center" rowspan="1" colspan="1">0.37</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">CD 4 count (cell/mm<sup>3</sup>)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> > 500</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 351–500</td><td align="center" rowspan="1" colspan="1">1.21 (0.34–4.40)</td><td align="center" rowspan="1" colspan="1">0.77</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.38 (0.18–0.78)</td><td align="center" rowspan="1" colspan="1">0.008</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 201–350</td><td align="center" rowspan="1" colspan="1">2.02 (0.61–6.77)</td><td align="center" rowspan="1" colspan="1">0.25</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.57 (0.28–1.17)</td><td align="center" rowspan="1" colspan="1">0.13</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> < 200</td><td align="center" rowspan="1" colspan="1">1.70 (0.30–9.57)</td><td align="center" rowspan="1" colspan="1">0.55</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.20 (0.05–0.73)</td><td align="center" rowspan="1" colspan="1">0.02</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Viral load (copies/ml)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> < 50</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 51–500</td><td align="center" rowspan="1" colspan="1">3.17 (0.79–12.68)</td><td align="center" rowspan="1" colspan="1">0.10</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.38 (0.10–1.38)</td><td align="center" rowspan="1" colspan="1">0.14</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 501–5000</td><td align="center" rowspan="1" colspan="1">1.27 (0.15–10.70)</td><td align="center" rowspan="1" colspan="1">0.83</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.86 (0.24–3.05)</td><td align="center" rowspan="1" colspan="1">0.82</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> > 5000</td><td align="center" rowspan="1" colspan="1">3.17 (0.61–16.51)</td><td align="center" rowspan="1" colspan="1">0.17</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">ART duration (months)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> > 60</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1 [Ref]</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> 30–60</td><td align="center" rowspan="1" colspan="1">0.71 (0.19–2.72)</td><td align="center" rowspan="1" colspan="1">0.62</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">1.78 (0.76–4.15)</td><td align="center" rowspan="1" colspan="1">0.18</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> < 30</td><td align="center" rowspan="1" colspan="1">0.61 (0.17–2.23)</td><td align="center" rowspan="1" colspan="1">0.46</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">0.71 (0.31–1.64)</td><td align="center" rowspan="1" colspan="1">0.43</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">Gender by tobacco use</td><td align="center" rowspan="1" colspan="1">7.72 (2.46–24.21)</td><td align="center" rowspan="1" colspan="1">0.001<xref ref-type="table-fn" rid="TFN0003">*</xref></td><td align="center" rowspan="1" colspan="1">10.87(2.30–51.4)</td><td align="center" rowspan="1" colspan="1">0.003</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Classification accuracy</italic></td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1"><italic>93.3</italic>%</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1">-</td><td align="center" rowspan="1" colspan="1"><italic>82.7</italic>%</td><td align="center" rowspan="1" colspan="1">-</td></tr></tbody></table><table-wrap-foot><fn><p>OR, odds ratio; AOR, adjusted odds ratio; ART, antiretroviral therapy; CI, confidence interval;</p></fn><fn id="TFN0003"><label>*</label><p>Variables that were included in the multivariate forward and backward stepwise regression model. Variables in final multivariate model are presented with adjusted odds ratio. BMI was considered as underweight (< 18.5 kg/m<sup>2</sup>), normal (18.5–24.9 kg/m<sup>2</sup>) and overweight (≥ 25.0 kg/m<sup>2</sup>).</p></fn></table-wrap-foot></table-wrap></sec><sec id="s20017"><title>Predictors of overweight in people on ART</title><p>In univariate analysis, male gender (OR: 0.33, <italic>p</italic> = 0.009) and physical activity (OR: 0.99, <italic>p</italic> = 0.001) significantly associated negatively with overweight. After controlling for tobacco use, CD4 count, viral load and ART duration in multivariate model, male gender (OR: 0.29, <italic>p</italic> = 0.04) and physical activity (OR: 0.99, <italic>p</italic> = 0.001) were independent negative predictors of overweight. Neither ART duration nor viral load or CD4 count was independently associated with overweight in multivariate analysis (<xref ref-type="table" rid="T0003">Table 3</xref>).</p></sec></sec><sec id="s0018"><title>Discussion</title><p>In this study, 8.9% of the participants were underweight and 36.4% were overweight. Similar to our finding, the prevalence of underweight in the general South African population was recently found to be 7.0%.<sup><xref rid="CIT0017" ref-type="bibr">17</xref></sup> However, the 50.8% prevalence of overweight in the general population<sup><xref rid="CIT0017" ref-type="bibr">17</xref></sup> was higher than the prevalence of overweight observed in our study. The prevalence of underweight and overweight among HIV-infected people on ART reported from rural KwaZulu Natal in South Africa<sup><xref rid="CIT0010" ref-type="bibr">10</xref></sup> are similar to the prevalence observed in our study. However, some low- to middle-income countries are still faced with a higher burden of underweight than overweight (<xref ref-type="table" rid="T0004">Table 4</xref>). Although there is a greater tendency to gain weight while taking ART, weight loss has been observed,<sup><xref rid="CIT0003" ref-type="bibr">3</xref></sup> and therefore, health professionals should monitor patients’ weight. An increase in weight among people on ART may be due to a return to good health in which the appetite and caloric intake increases accompanied with a lack of physical activity.<sup><xref rid="CIT0001" ref-type="bibr">1</xref></sup> On the contrary, literature suggests that weight loss during the first 3 months after initiation of ART was associated with symptoms such as difficulty in breathing, nausea, vomiting and oral opportunistic infections.<sup><xref rid="CIT0003" ref-type="bibr">3</xref></sup> Oral opportunistic infections can limit the ability to chew and swallow food leading to loss of appetite and reduced caloric intake. Additionally, poor adherence to ART or drug failure that may result in disease progression may explain a weight loss in people on ART.<sup><xref rid="CIT0003" ref-type="bibr">3</xref></sup> However, our study did not evaluate these symptoms or drug adherence. In the United States<sup><xref rid="CIT0006" ref-type="bibr">6</xref></sup> and the United Kingdom,<sup><xref rid="CIT0007" ref-type="bibr">7</xref></sup> underweight was observed in ≤ 1% and overweight in ≥ 50% of people on ART (<xref ref-type="table" rid="T0004">Table 4</xref>). Although an increasing number of people on ART in developed countries are overweight, in developing countries the co-existence of underweight and overweight among HIV-infected people on ART is a burden that is far from over, despite efforts to eradicate malnutrition. Fears are that the problem of malnutrition (underweight) may be compounded in the future by climate change impacting on agricultural yields and food security.<sup><xref rid="CIT0023" ref-type="bibr">23</xref></sup> Underweight among patients on ART in low- to middle-income countries was shown to contribute to excess early mortality, possibly due to poor immune reconstitution arising from deficient nutritional status.<sup><xref rid="CIT0024" ref-type="bibr">24</xref></sup> Similar to the general population,<sup><xref rid="CIT0004" ref-type="bibr">4</xref>,<xref rid="CIT0005" ref-type="bibr">5</xref></sup> overweight in people on ART may increase the risk of developing CVD. The levels of C-reactive protein an inflammatory marker were similar in the underweight group and in the overweight group, as these extreme weight statuses are characterized by inflammation.<sup><xref rid="CIT0025" ref-type="bibr">25</xref></sup> Adipose tissue in overweight individuals may produce proinflammatory cytokine such as interleukin-6, a significant stimulator of C-reactive protein,<sup><xref rid="CIT0026" ref-type="bibr">26</xref></sup> whereas opportunistic infections that may be present in underweight individuals are associated with increased levels of C-reactive protein.<sup><xref rid="CIT0027" ref-type="bibr">27</xref></sup> However, individuals with very low CD4 counts less than 50 cells/µl have been observed to produce a small C-reactive response.<sup><xref rid="CIT0027" ref-type="bibr">27</xref></sup></p><table-wrap id="T0004" orientation="portrait" position="float"><label>TABLE 4</label><caption><p>Prevalence of underweight and overweight in patients on ART in previous studies.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Author</th><th valign="top" align="center" rowspan="1" colspan="1">Study design/Country</th><th valign="top" align="center" rowspan="1" colspan="1">Characteristics of participants</th><th valign="top" align="center" rowspan="1" colspan="1">Underweight (%)</th><th valign="top" align="center" rowspan="1" colspan="1">Overweight (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Crum-Ciaflone et al., 2008<sup><xref rid="CIT0006" ref-type="bibr">6</xref></sup></td><td align="left" rowspan="1" colspan="1">Retrospective/USA</td><td align="left" rowspan="1" colspan="1">- Men</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">63</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 18 years and above</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- Mean ART duration 54 months</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">McCormick et al., 2014<sup><xref rid="CIT0007" ref-type="bibr">7</xref></sup></td><td align="left" rowspan="1" colspan="1">A whole year survey/United Kingdom</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">African Black: 0.4</td><td align="center" rowspan="1" colspan="1">African Black: 77</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">-18 years and above</td><td align="center" rowspan="1" colspan="1">F-1; M-0</td><td align="center" rowspan="1" colspan="1">F- 80.6; M- 70</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">-Any duration of ART</td><td align="center" rowspan="1" colspan="1">White Caucasian- 1.7</td><td align="center" rowspan="1" colspan="1">White Caucasian- 49.2</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">F- 4; M-1</td><td align="center" rowspan="1" colspan="1">F- 52; M- 48.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Wasie et al., 2010<sup><xref rid="CIT0008" ref-type="bibr">8</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross-sectional/northw est Ethiopia</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">27.8</td><td align="center" rowspan="1" colspan="1">4.8</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 15 years and above</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">-Any duration of ART</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Mustapha et al., 2011<sup><xref rid="CIT0009" ref-type="bibr">9</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross- sectional/Nigeria</td><td align="left" rowspan="1" colspan="1">- Males and females</td><td align="center" rowspan="1" colspan="1">24.1</td><td align="center" rowspan="1" colspan="1">27.9</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 18 to 50 years old</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- ART duration ≥ 6 months</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Malaza et al., 2012<sup><xref rid="CIT0010" ref-type="bibr">10</xref></sup></td><td align="left" rowspan="1" colspan="1">Population survey/South Africa</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">7.1</td><td align="center" rowspan="1" colspan="1">46</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- Adults</td><td align="center" rowspan="1" colspan="1">F-5.5; M-14.4</td><td align="center" rowspan="1" colspan="1">F-53.1; M-15.5</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- Any duration of ART</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">de Senna et al., 2014<sup><xref rid="CIT0018" ref-type="bibr">18</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross-sectional/Brazil</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">5.5</td><td align="center" rowspan="1" colspan="1">37.1</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 20 years and above</td><td align="center" rowspan="1" colspan="1">F-7.6; M-3.8</td><td align="center" rowspan="1" colspan="1">F-42.9; M-32.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Frantz & Murenzi, 2013<sup><xref rid="CIT0019" ref-type="bibr">19</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross-sectional/Rwand a</td><td align="left" rowspan="1" colspan="1">- Males and females</td><td align="center" rowspan="1" colspan="1">F- 4; M- 1.1</td><td align="center" rowspan="1" colspan="1">F- 46; M-22.1</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 18 years and above</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- ART duration ≥ 12 months</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Gedle et al., 2015<sup><xref rid="CIT0020" ref-type="bibr">20</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross- sectional/southern Ethiopia</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">25.2</td><td align="center" rowspan="1" colspan="1">NA</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 18 years and above</td><td align="center" rowspan="1" colspan="1">F-24.9; M-25.9</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- Any duration of ART</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Anand & Puri, 2014<sup><xref rid="CIT0021" ref-type="bibr">21</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross- sectional/India</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">40.0</td><td align="center" rowspan="1" colspan="1">15.0</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 21 years and above</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- ART duration ≤ 6 months</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Mehta & Khatri, 2013<sup><xref rid="CIT0022" ref-type="bibr">22</xref></sup></td><td align="left" rowspan="1" colspan="1">Cross- sectional/Nepal</td><td align="left" rowspan="1" colspan="1">- Men and women</td><td align="center" rowspan="1" colspan="1">24.7</td><td align="center" rowspan="1" colspan="1">10.6</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- 19–73 years old</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">- ART duration ≥ 3 months</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn><p>F, female; M, male; ART, antiretroviral therapy; NA, not assessed. Underweight (< 18.5 kg/m<sup>2</sup>), and overweight (≥ 25.0 kg/m<sup>2</sup>).</p></fn></table-wrap-foot></table-wrap><p>In this study, overweight was disproportionately more frequent in women than in men, whereas underweight was more frequent in men than in women, as was reported among HIV-infected people in KwaZulu Natal, South Africa<sup><xref rid="CIT0010" ref-type="bibr">10</xref></sup> and in the general population of South Africa.<sup><xref rid="CIT0017" ref-type="bibr">17</xref></sup> In contrast, studies from Brazil<sup><xref rid="CIT0018" ref-type="bibr">18</xref></sup> and Rwanda<sup><xref rid="CIT0019" ref-type="bibr">19</xref></sup> reported a higher prevalence of underweight and overweight in women than men. In Ethiopia, the prevalence of underweight was similar among women and men.<sup><xref rid="CIT0020" ref-type="bibr">20</xref></sup></p><p>Physical inactivity<sup><xref rid="CIT0028" ref-type="bibr">28</xref></sup> and low tobacco use<sup><xref rid="CIT0029" ref-type="bibr">29</xref>,<xref rid="CIT0030" ref-type="bibr">30</xref></sup> may contribute to the higher prevalence of overweight in women on ART. In addition, studies among black African women from sub-Saharan Africa suggest high target ‘ideal’ weight, less dissatisfaction with larger body shape and poor awareness of CVD risk as main contributing factors to overweight among HIV-infected women on ART.<sup><xref rid="CIT0007" ref-type="bibr">7</xref>,<xref rid="CIT0017" ref-type="bibr">17</xref>,<xref rid="CIT0031" ref-type="bibr">31</xref></sup> Black African men on ART on the contrary are less keen to be obese.<sup><xref rid="CIT0007" ref-type="bibr">7</xref></sup></p><p>Our study showed that men who used tobacco were more likely to be underweight than men who did not use tobacco. Further analysis to explain this increased risk of underweight among smokers showed that a higher proportion of smokers than non-smokers (11.8% vs. 7.7%) had a viral load greater than 5000 copies/ml and were physically active (100% vs. 95%). Previously, HIV infection was shown to increase the risk of underweight through increased resting energy expenditure,<sup><xref rid="CIT0003" ref-type="bibr">3</xref></sup> whereas the use of tobacco was shown to reduce appetite.<sup><xref rid="CIT0032" ref-type="bibr">32</xref></sup> People on ART who were not physically active were more likely to be overweight than those physically active as was also observed in Rwanda.<sup><xref rid="CIT0019" ref-type="bibr">19</xref></sup> Physical activity may reduce the risk of being overweight<sup><xref rid="CIT0033" ref-type="bibr">33</xref></sup> and has a potential anti-inflammatory effect in people on ART.<sup><xref rid="CIT0034" ref-type="bibr">34</xref></sup></p><p>In our study, neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight. Similarly, a study from United States showed that demographics and ART duration could not independently predict the increase of weight in people on ART.<sup><xref rid="CIT0006" ref-type="bibr">6</xref></sup> The relationship between ART duration and BMI is inconsistent.<sup><xref rid="CIT0006" ref-type="bibr">6</xref>,<xref rid="CIT0035" ref-type="bibr">35</xref>,<xref rid="CIT0036" ref-type="bibr">36</xref></sup> In a longitudinal study, weight gain was observed in a short ART duration (24 weeks) that was followed by weight loss in people treated with stavudine-based ART and maintained weight gain in people treated with tenofovir after 144 weeks.<sup><xref rid="CIT0037" ref-type="bibr">37</xref></sup> Therefore, according to Crum-Cianflone et al. (2008),<sup><xref rid="CIT0006" ref-type="bibr">6</xref></sup> the differences in ART duration may account for variations in this relationship between ART duration and BMI.</p><p>According to the WHO strategy to tackle nutritional problems, stakeholders at global, regional and local levels have a mandate to improve diets and physical activity patterns of the population.<sup><xref rid="CIT0038" ref-type="bibr">38</xref></sup> In line with this strategy, South Africa introduced the ‘Move for your Health’ programme aimed at promoting physical activity. An initiative of major private health insurers the ‘Wellness programme’ rewards and recognizes those maintaining a healthy weight.<sup><xref rid="CIT0039" ref-type="bibr">39</xref></sup> In addition, programmes such as social grants, the provision of nutritional supplements to children and those on ART are aimed at alleviating undernutrition. However, the impact and effectiveness of these initiatives remains unclear.</p><p>Our study is one of a few in South Africa to provide information on the problem of underweight among people on ART in a rural area. The limitations of this study include its cross-sectional design that limits inference. In addition, fruit and vegetable intake, physical activity, tobacco and alcohol use were self-reported, and recall bias may have influenced results. Although our study did not assess the full dietary intake, an assessment of fruit and vegetable intake showed that people in all weight status categories had a lower fruit and vegetable daily intake than recommended. In agreement to this finding, a study conducted in a South African rural and semi-rural area, similar to Dikgale HDSS, found that the intake of fruit and vegetables in that community was low.<sup><xref rid="CIT0040" ref-type="bibr">40</xref></sup> Overcoming this problem particularly in rural areas may therefore remain a challenge, as evidence suggests an association of perceived expense, and low income with low fruit and vegetable intake.<sup><xref rid="CIT0040" ref-type="bibr">40</xref>,<xref rid="CIT0041" ref-type="bibr">41</xref></sup> A low level of fruit and vegetable intake may lead to deficiencies in vitamins, predisposing people to a wide range of conditions including CVD, cancers and cataracts<sup><xref rid="CIT0041" ref-type="bibr">41</xref>,<xref rid="CIT0042" ref-type="bibr">42</xref></sup> and may accelerate HIV disease progression.<sup><xref rid="CIT0043" ref-type="bibr">43</xref></sup> Most of our participants were older people as the majority of young adults live away from home as temporary migrants for employment reasons.<sup><xref rid="CIT0044" ref-type="bibr">44</xref></sup> Convenient sampling was used to recruit participants. However, recruitment was conducted for a whole month cycle, giving all patients collecting their medication equal opportunity to participate. We also acknowledge the small sample size of our study. Further longitudinal cohort intervention studies that would monitor weight changes in people on ART are needed.</p></sec><sec id="s0019"><title>Conclusion</title><p>In a rural community in the Limpopo province of South Africa, a high proportion of people on ART were overweight and smaller proportions were underweight. Men who used tobacco had a higher risk of being underweight than non-tobacco users. Female gender and physical inactivity increased the risk of being overweight. There is need to simultaneously address the two extreme weight problems in people on ART through educating this vulnerable population on the benefits of staying away from tobacco use, engaging in physical activity and increasing awareness on CVD risk.</p></sec></body><back><ack><title>Acknowledgements</title><p>The authors acknowledge the collaboration from our participants and the assistance from counsellors and professional nurses during recruitment. They are grateful to the Department of Health for granting permission to conduct the study in Dikgale clinics. They are thankful for the support of the Belgium Development Co-operation through Vlaamse Interuniversitaire Raad-University Development Cooperation (VLIR-UOS) within the framework of an institutional collaboration between the University of Limpopo and Flemish universities.</p><sec id="s20020"><title>Competing interests</title><p>The authors declare that they have no competing interests.</p></sec><sec id="s20021"><title>Authors’ contributions</title><p>M.A. was the project leader. M.A. and J-P.v.G. contributed substantially to the conception and design of study. F.M. perfomed the experiments and collected data. F.M. performed statistical analysis, interpreted the data and drafted the manuscript. M.A., J-P.v.G. and R.C. were involved with the interpretation and presentation of data, and the critical review of the manuscript. All authors read and approved the final manuscript.</p></sec></ack><fn-group><fn><p><bold>How to cite this article:</bold> Mashinya F, Alberts M, Colebunders R, Van Geertruyden J-P. Weight status and associated factors among HIV-infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa. 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