Abstract
IntroductionWeight gain following antiretroviral therapy (ART) initiation is common, potentially predisposing some persons with HIV (PWH) to cardio‐metabolic disease. We assessed relationships between ART drug class and weight change among treatment‐naïve PWH initiating ART in the North American AIDS Cohort Collaboration on Research and Design (NA‐ACCORD).MethodsAdult, treatment‐naïve PWH in NA‐ACCORD initiating integrase strand transfer inhibitor (INSTI), protease inhibitor (PI) or non‐nucleoside reverse‐transcriptase inhibitor (NNRTI)‐based ART on/after 1 January 2007 were followed through 31 December 2016. Multivariate linear mixed effects models estimated weight up to five years after ART initiation, adjusting for age, sex, race, cohort site, HIV acquisition mode, treatment year, and baseline weight, plasma HIV‐1 RNA level and CD4+ cell count. Due to shorter follow‐up for PWH receiving newer INSTI drugs, weights for specific INSTIs were estimated at two years. Secondary analyses using logistic regression and all covariates from primary analyses assessed factors associated with >10% weight gain at two and five years.ResultsAmong 22,972 participants, 87% were male, and 41% were white. 49% started NNRTI‐, 31% started PI‐ and 20% started INSTI‐based regimens (1624 raltegravir (RAL), 2085 elvitegravir (EVG) and 929 dolutegravir (DTG)). PWH starting INSTI‐based regimens had mean estimated five‐year weight change of +5.9kg, compared to +3.7kg for NNRTI and +5.5kg for PI. Among PWH starting INSTI drugs, mean estimated two‐year weight change was +7.2kg for DTG, +5.8kg for RAL and +4.1kg for EVG. Women, persons with lower baseline CD4+ cell counts, and those initiating INSTI‐based regimens had higher odds of >10% body weight increase at two years (adjusted odds ratio = 1.37, 95% confidence interval: 1.20 to 1.56 vs. NNRTI).ConclusionsPWH initiating INSTI‐based regimens gained, on average, more weight compared to NNRTI‐based regimens. This phenomenon may reflect heterogeneous effects of ART agents on body weight regulation that require further exploration.
Highlights
Weight gain following antiretroviral therapy (ART) initiation is common, potentially predisposing some persons with HIV (PWH) to cardio-metabolic disease
In the prospective AIDS Clinical Trial Group (ACTG) study A5257, the use of RAL with tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as an initial ART regimen was associated with greater increases in waist circumference and increased odds of a >10% weight gain at 96 weeks, compared to ART regimens including ritonavirboosted darunavir or ritonavir-boosted atazanavir, each combined with TDF/FTC [18,19]
Our findings indicate differential risk for weight gain associated with use of specific integrase strand transfer inhibitor (INSTI) drugs, which was higher among DTG and RAL recipients compared to persons receiving EVG
Summary
Weight gain following antiretroviral therapy (ART) initiation is common, potentially predisposing some persons with HIV (PWH) to cardio-metabolic disease. PWH starting INSTI-based regimens had mean estimated five-year weight change of +5.9kg, compared to +3.7kg for NNRTI and +5.5kg for PI. Among PWH starting INSTI drugs, mean estimated two-year weight change was +7.2kg for DTG, +5.8kg for RAL and +4.1kg for EVG. Weight gain following antiretroviral therapy (ART) initiation is common among persons with HIV (PWH), those with more pronounced CD4+ cell count (CD4) depletion or lower pre-ART body mass index (BMI) [1,2,3]. INSTI-based ART regimens are the recommended first-line treatment for most PWH [12], but several recent studies, primarily from single sites or cohorts, report greater weight gain among persons receiving INSTIbased ART regimens for initial therapy as compared to protease inhibitor (PI) and non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. In the prospective AIDS Clinical Trial Group (ACTG) study A5257, the use of RAL with tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as an initial ART regimen was associated with greater increases in waist circumference and increased odds of a >10% weight gain at 96 weeks, compared to ART regimens including ritonavirboosted darunavir or ritonavir-boosted atazanavir, each combined with TDF/FTC [18,19]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
