Changes in Body Mass Index Associated with Antiretroviral Regimen Switch Among Treatment-Experienced, Virologically Suppressed People Living with HIV in the United States

Karam Mounzer,Cassidy Henegar,Janet Lo,Laurence Brunet,Melissa Crawford,Vani Vannappagari,Jennifer Fusco,Jean Van Wyk,Ricky Hsu,Gregory Fusco

doi:10.1089/aid.2020.0287

Abstract

With obesity on the rise among people living with HIV (PLWH), there is growing concern that weight gain may result as an undesired effect of antiretroviral therapy (ART). This analysis sought to assess the association between ART regimens and changes in body mass index (BMI) among ART-experienced, virologically suppressed PLWH. ART-experienced, virologically suppressed PLWH ≥18 years of age in the Observational Pharmacoepidemiology Research and Analysis (OPERA) cohort were included for analysis if prescribed a new regimen containing one of the following core agents: dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), rilpivirine (RPV), or boosted darunavir (bDRV), for the first time between August 1, 2013 and December 31, 2017. Multivariable linear regression was used to assess the association between regimen and mean changes in BMI at 6, 12, and 24 months after switch. In unadjusted analyses, BMI increases ranged from 0.30 kg/m2 (bDRV) to 0.83 kg/m2 (RPV) at 24 months following switch, but gains were observed with every regimen. In adjusted analyses, compared to DTG, only bDRV was associated with a smaller increase in BMI at all time points, while EVG/c and RAL were associated with smaller increases in BMI at 6 months only. Overall, results were consistent in analyses stratified by baseline BMI category. BMI increases were relatively small but followed an upward trend over time in this cohort of treatment-experienced, suppressed PLWH. Gains were attenuated with a longer period of follow-up. BMI gains did not differ by regimens, except for bDRV regimens, which were consistently associated with smaller BMI increases than DTG.

Highlights

There is growing evidence showing that weight gain, notably obesity, is on the rise among people living with HIV (PLWH).[1,2] In Canada and the United States, among14,084 PLWH in NA-ACCORD, the median body mass index (BMI) at antiretroviral therapy (ART) initiation increased from 23.8 kg/m2 (9% obese, BMI ‡30 kg/m2) in 1998 to 24.8 kg/m2 (18% obese) in 2010.2 Among 1,682 PLWH in the United States Military Natural History Study, the a Karam Mounzer et al 2021; Published by Mary Ann Liebert, Inc
With obesity on the rise among people living with HIV (PLWH), there is growing concern that weight gain may result as an undesired effect of antiretroviral therapy (ART)
ART-experienced, virologically suppressed PLWH ‡18 years of age in the Observational Pharmacoepidemiology Research and Analysis (OPERA) cohort were included for analysis if prescribed a new regimen containing one of the following core agents: dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), rilpivirine (RPV), or boosted darunavir, for the first time between August 1, 2013 and December 31, 2017

Summary

Introduction

There is growing evidence showing that weight gain, notably obesity, is on the rise among people living with HIV (PLWH).[1,2] In Canada and the United States, among14,084 PLWH in NA-ACCORD, the median body mass index (BMI) at antiretroviral therapy (ART) initiation increased from 23.8 kg/m2 (9% obese, BMI ‡30 kg/m2) in 1998 to 24.8 kg/m2 (18% obese) in 2010.2 Among 1,682 PLWH in the United States Military Natural History Study, the a Karam Mounzer et al 2021; Published by Mary Ann Liebert, Inc. Several studies have reported weight gain when ART-naive PLWH start ART, with BMI increases ranging from 0.4 to 1.3 kg/m2 over 12 to 24 months, and body weight increases of 2.7 to 4.4 kg over 12 to 24 months.[7,8,9,10,11,12,13,14] Among ART-naive PLWH, the use of integrase strand transfer inhibitors (INSTI) has been associated with greater weight gain than other existing classes.[7,15] among ART-experienced PLWH, BMI changes associated with different classes have been mixed. Some studies suggest greater weight gain when switching to an INSTI-based regimen, whether virologically suppressed at switch[16,17,18,19] or not.[20,21]

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Discussion

Conclusion