Weight gain and metabolic effects in persons with HIV who switch to ART regimens containing integrase inhibitors or tenofovir alafenamide

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Palella, Frank J. ; Hou, Qingjiang ; Li, Jun ; Mahnken, Jonathan ; Carlson, Kimberly J. ; Durham, Marcus ; Ward, Douglas ; Fuhrer, Jack ; Tedaldi, Ellen ; Novak, Richard ; Buchacz, Kate
• Description:
  Background:
  
  The timing and magnitude of antiretroviral therapy-associated weight change attributions are unclear.
  
  Setting:
  
  HIV Outpatient Study participants.
  
  Methods:
  
  We analyzed 2007-2018 records of virally suppressed (VS) persons without integrase inhibitor (INSTI) experience who switched to either INSTI- or another non-INSTI-based ART, and remained VS. We analyzed BMI changes using linear mixed models (LMM), INSTI-and tenofovir alafenamide (TAF) contributions to BMI change by LMM-estimated slopes, and BMI inflection points.
  
  Results:
  
  Among 736 participants (5,316 person-years), 441 (60%) switched to INSTI-based ART; the remainder to non-INSTI-based ART. Mean follow-up was 7.15 years for INSTI recipients, 7.35 years for non-INSTI. Pre-switch, INSTI and non-INSTI groups had similar median BMI (26.3 versus 25.9 kg/m2, p=0.41). INSTI regimens included raltegravir (178), elvitegravir (112) and dolutegravir (143). Monthly BMI increases post-switch were greater with INSTI than non-INSTI (0.0525 versus 0.006, p<0.001). A BMI inflection point occurred eight months after switch among INSTI users; slopes were similar regardless of TAF use immediately post-switch. Among INSTI+TAF users, during eight months post-switch, 87% of BMI slope change was associated with INSTI use, 13% with TAF use; after eight months, estimated contributions were 27% and 73%, respectively. For non-INSTI+TAF, 84% of BMI gain was TAF-associated consistently post switch. Persons switching from TDF to TAF had greater BMI increases than others (p<0.001).
  
  Conclusion:
  
  Among VS persons who switched ART, INSTI and TAF use were independently associated with BMI increases. During eight months post-switch, BMI changes were greatest and most associated with INSTI use; afterward, gradual BMI gain was largely TAF-associated.
  
  
• Subjects:
  HIV Infections Humans Integrase Inhibitors Weight Gain
• Keywords:
  Integrase Inhibitor Metabolic Effects TAF Viral Suppression Weight Gain
• Source:
  J Acquir Immune Defic Syndr. 92(1):67-75
• Pubmed ID:
  36150045
• Pubmed Central ID:
  PMC11706360
• Document Type:
  Journal Article
• Funding:
  75D30120C08752/CC/CDC HHSUnited States/ ; 75D30120C08752/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  92
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:69927ec586ce68a3338aed565d68ed8e2b12122267f25778c26deb2c228af8950c8438a3eb5227c0f13ed3b2a0d334acbbfd0ad7180d8b0783ddd3d2aae58b88
• Download URL:
  https://stacks.cdc.gov/view/cdc/175439/cdc_175439_DS1.pdf
• File Type:
  [PDF - 384.81 KB ]