Background With the introduction of integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART), persons living with HIV have a potent new treatment option. Recently, providers at our large treatment clinic noted weight gain in several patients switched from efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) to dolutegravir/abacavir/lamivudine (DTG/ABC/3TC). In this study, we evaluated weight change in patients with sustained virologic suppression switched from EFV/TDF/FTC to an INSTI-containing regimen. Methods We performed a retrospective observational cohort study among adults on EFV/TDF/FTC for at least two years who had virologic suppression. We assessed weight change over 18 months in patients who switched from EFV/TDF/FTC to an INSTI-containing regimen or a protease inhibitor (PI)-containing regimen versus those on EFV/TDF/FTC over the same period. In a sub-group analysis, we compared patients switched to DTG/ABC/3TC versus raltegravir- or elvitegravir-containing regimens. Results A total of 495 patients were included: 136 switched from EVF/TDF/FTC to an INSTI-containing regimen and 34 switched to a PI-containing regimen. Patients switched to an INSTI-containing regimen gained an average of 2.9 kg at 18 months compared to 0.9 kg among those continued on EFV/TDF/FTC (p=0.003), while those switched to a PI regimen gained 0.7 kg (p=0.81). Among INSTI regimens, those switched to DTG/ABC/3TC gained the most weight at 18 months (5.3 kg, p=0.001 compared to EFV/TDF/FTC). Conclusion Adults living with HIV with viral suppression gained significantly more weight after switching from daily, fixed dose EFV/TDF/FTC to an INSTI-based regimen compared to those remaining on EFV/TDF/FTC. This weight gain was greatest among patients switching to DTG/ABC/3TC.

BackgroundIntegrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) offers persons living with HIV a potent new treatment option. Recently, local HIV clinicians noted weight gain in patients who switched from daily, fixed-dose efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) to fixed-dose dolutegravir/abacavir/lamivudine (DTG/ABC/3TC). To assess whether regimen switch was significantly associated with weight gain, we evaluated body weight over time among patients with sustained virologic suppression who switched from EFV/TDF/FTC to an INSTI-containing regimen, including DTG/ABC/3TC.MethodsWe analyzed data from adult patients on EFV/TDF/FTC for >=2 years with consistent plasma HIV-1 RNA <1000 copies/mL prior to date of switch (or date of sham switch for those who remained on EFV/TDF/FTC). All maintained HIV-1 RNA <1000 copies/mL for >=18 months post-switch. We assessed weight change over 18 months in patients switched to an INSTI-containing regimen or a protease inhibitor (PI)-containing regimen vs. those remaining on EFV/TDF/FTC over the same period. In a sub-group analysis, we compared patients switched to DTG/ABC/3TC vs. raltegravir- or elvitegravir-containing regimens. Linear mixed effects models assessed mean differences in weight over time, adjusting for baseline age, sex, race, CD4+ count and weight.ResultsAmong 495 patients, 136 switched to an INSTI-containing regimen, 34 switched to a PI-containing regimen, and 325 remained on EFV/TDF/FTC. Patients switched to an INSTI-containing regimen gained an average of 2.9 kilograms (kg) at 18 months compared with 0.9 kg among those continued on EFV/TDF/FTC (P = 0.003, Figure a), while those switched to a PI regimen gained 0.7 kg (P = 0.81, Figure b). Among INSTI regimens, those switched to DTG/ABC/3TC gained 5.3 kg at 18 months, which was more than raltegravir or elvitegravir regimens (P = 0.19, Figure c) and significantly more than those continued on EFV/TDF/FTC (P = 0.001, Figure d).ConclusionSwitching from daily, fixed-dose EFV/TDF/FTC to an INSTI-containing regimen among patients with virologic control was associated with weight gain at 18 months. This weight gain was particularly profound among those switching to DTG/ABC/3TC.Disclosures All authors: No reported disclosures.

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BackgroundViral suppression (VS) among people living with HIV (PLWH), the goal of the HIV care continuum, leads to improved patient outcomes and decreased HIV transmission. Patient portals are online tools that enable patient interaction with healthcare systems and may increase patient engagement and improve health outcomes. We examined whether portal access was associated with VS among PLWH.MethodsWe conducted an observational cohort study among PLWH aged ≥18 years who had ≥1 HIV healthcare provider visit at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from January 1, 2011–December 31, 2015. Patient portal access was defined as being registered for a portal account at any point in the year prior. VS was defined as having ≥1 viral load (VL) measured and the last VL ≤200 copies/ml within a given year. The adjusted relative risk (aRR) of VS was estimated with modified Poisson regression and robust standard errors for multiple outcomes per individual. Models were adjusted for all covariates in the Figure and for year since first kept appointment. Missing data were multiply imputed.ResultsThe study population included 4,237 PLWH; median age was 43 years (IQR 33–50), 78% were male, 41% were black, and 60% reported male–male sexual contact (MSM). Of the 57% who had portal access during the study period, median age was 42 years (IQR 31–49), 86% were male, 30% were black, and 75% were MSM. In adjusted analysis, portal access was independently associated with improved VS (aRR = 1.19, 95% CI 1.16–1.21 vs. no portal access) (Figure). Increasing age and sexual contact (vs. injection drug use) remained associated with improved VS; black race (vs. white race), lower socioeconomic status, and higher baseline VL remained associated with poor VS after accounting for portal access (Figure).ConclusionPortal access was independently associated with improved VS, although sociodemographic disparities in VS persisted. Additionally, there were sociodemographic disparities in patient portal access. There may be important unmeasured confounders such as health literacy and educational attainment. Additional prospective studies are needed to determine whether patient portal access leads to improved VS among PLWH.Disclosures P. Rebeiro, NIH: Grant Investigator, Research grant; G. Jackson, Vanderbilt Center for Effective Health Communication: Grant Investigator, Research grant; Agency for Healthcare Research and Quality: Grant Investigator, Research grant; American Medical Informatics Association: Board Member, Research support; A. Pettit, NIH/NIAID - K08AI104352: Grant Investigator, Research grant