Abstract
An unexpected increase in weight gain has recently been reported in the course of integrase strand transfer inhibitors (INSTI) treatment. The possibility of this effect in people who are perinatally infected with HIV (PHIV) and thus exposed to lifelong therapy needs to be explored. This is a retrospective multicenter case-control study. Adults with PHIV followed between 2010 and 2019 in two outpatient services in Northern Italy were included if they had at least two weight measures in two successive years of observation. Patients were considered as cases if they were switched to INSTI (INSTI group), or controls if they were never exposed to INSTI (non-INSTI group). The date of the switch in cases was considered to be the baseline (T0), while it was randomly selected in controls. Mixed effect models were used to assess the weight changes in INSTI and non-INSTI groups. A total of 66 participants, 50.0% women, 92.4% Caucasian, were included. Median follow-up was 9 years (range 2–10): 4 years (range 1–8) before and 3 (range 1–9) after-T0. Mean age at the last study visit was 27.3 (±4.8) years, and mean CD4+ T-cells were 820.8 (±323.6) cells/mm3. Forty-five patients were switched to INSTI during the study, while 21 remained in the non-INSTI group. The INSTI group experienced a mean increase (pre-post T0) in bodyweight of 0.28 kg/year (95% CI − 0.29; 0.85, p = 0.338), while in the non-INSTI group, the mean increase was 0.36 kg/year (95% CI − 0.47; 1.20, p = 0.391), without a significant difference between groups (p for interaction between time and treatment regimen = 0.868). Among patients on INSTI, the weight gain after T0 was higher than pre-T0, amounting to +0.28 kg/year (95% CI − 0.29; 0.85), although this difference did not reach significance (p = 0.337). PHIV switched to an INSTI-based regimen did not experience an excessive weight gain compared to those who were treated with a non-INSTI based regimen in our cohort.
Highlights
Several recent studies have highlighted an unexpected adverse effect of new antiretroviral drugs, namely an increase in weight gain among people living with HIV (PLWHIV)
We evaluated weight changes over a 10-year period in young adult perinatally infected with HIV (PHIV) and found that all patients experienced an increase in weight during the observation, this increase was not linked to integrase strand transfer inhibitors (INSTI) use
In people living with HIV infection during adulthood, a greater than expected increase of weight was noticed in cases treated with both first line [3,5,28] and switching strategies [7,29] with INSTIs
Summary
Several recent studies have highlighted an unexpected adverse effect of new antiretroviral drugs, namely an increase in weight gain among people living with HIV (PLWHIV). Multiple drugs have been blamed to be a possible trigger of this side effect [1,2], and among anchor drugs, integrase strand transfer inhibitors (INSTIs) seem to be those with the highest impact on weight [3,4,5,6]. Adolescents living with HIV experience multiple forms of stigma, which can further compromise their self-image and weight gain would be even more relevant for them [17]
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