A Randomized Comparison of Anthropomorphic Changes With Preferred and Alternative Efavirenz-Based Antiretroviral Regimens in Diverse Multinational Settings

Erlandson, Kristine M.; Taejaroenkul, Sineenart; Smeaton, Laura; Gupta, Amita; Singini, Isaac; Lama, Javier R.; Mngqibisa, Rosie; Firnhaber, Cynthia; Cardoso, Sandra Wagner; Kanyama, Cecilia; Silva, Andre L. Machado da; Hakim, James; Kumarasamy, Nagalingeswaran; Campbell, Thomas; Hughes, Michael D.

doi:10.1093/ofid/ofv095

Cited by 23 publications

(21 citation statements)

References 32 publications

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“…In an AIDS Clinical Trial Group (ACTG) study of ART initiation in resource-diverse settings (A5175), more than 25% of participants were classified as overweight or obese at entry, and approximately 40% of participants were overweight or obese by week 144[8]. Some weight gain following ART initiation may be attributable to a “return to health” phenomenon; however, excessive weight gain can occur, with persons with the highest pre-ART HIV-1 RNA or lowest CD4 + T lymphocyte counts at risk for greater weight gain[10, 11].…”

Section: Burden Of Obesity and Visceral Adipositymentioning

confidence: 99%

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

Lake

2017

Curr HIV/AIDS Rep

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Purpose of Review To summarize knowledge of the prevalence, relevant physiology and consequences of obesity and visceral adiposity in HIV-infected adults, including highlighting gaps in current knowledge and future research directions. Recent Findings Similar to the general population, obesity prevalence is increasing among HIV-infected persons, and obesity and visceral adiposity are associated with numerous metabolic and inflammatory sequelae. However, HIV- and antiretroviral therapy (ART)-specific factors may contribute to fat gain and fat quality in treated HIV infection, particularly to the development of visceral adiposity, and sex differences may exist. Summary Obesity and visceral adiposity commonly occur in HIV-infected persons and have significant implications for morbidity and mortality. Future research should aim to better elucidate the HIV- and ART-specific contributors to obesity and visceral adiposity in treated HIV infection, with the goal of developing targeted therapies for the prevention and treatment of obesity and visceral adiposity in the modern ART era.

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Section: Burden Of Obesity and Visceral Adipositymentioning

confidence: 99%

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

Lake

2017

Curr HIV/AIDS Rep

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“…ART initiation is often associated with weight gain partially attributed to a “return to health” phenomenon, with greater increases in weight seen in persons with the highest pre-ART HIV-1 RNA or lowest CD4+ T lymphocyte counts [8, 9]. In an AIDS Clinical Trial Group (ACTG) study (A5175) of ART initiation in resource-diverse settings, more than 25% of participants were overweight or obese at entry, and approximately 40% of participants were overweight or obese by week 144 [10]. These findings are consistent with prior observational studies on anthropomorphic changes in both resource-limited and resource-plentiful settings [11-13].…”

Section: Discussionmentioning

confidence: 99%

“…However, all cases of lipoatrophy occurred in the 3TC/ZDV arm, which also had greater gains in waist-hip ratio (suggestive of subtle hip lipoatrophy with relative VAT gain). Among more contemporary regimens, these differences are less apparent [10]. In ACTG study A5224s, participants randomized to ATV/r had a small but significantly greater increase in body weight than participants randomized to EFV-based therapy [123], with no significant differences seen by NRTI backbone (ABC/3TC or TDF/FTC).…”

Section: Discussionmentioning

confidence: 99%

Fat Matters: Understanding the Role of Adipose Tissue in Health in HIV Infection

Erlandson

Lake

2016

Curr HIV/AIDS Rep

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More than one-third of adults in the United States are obese, and obesity-related disease accounts for some of the leading causes of preventable death. Mid-life obesity may be a strong predictor of physical function impairment later in life regardless of body mass index (BMI) in older age, highlighting the benefits of obesity prevention on health throughout the lifespan. Adipose tissue disturbances including lipodystrophy and obesity are prevalent in the setting of treated and untreated HIV infection. This article will review current knowledge on fat disturbances in HIV-infected persons, including therapeutic options and future directions.

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“…The initiation of cART is usually associated with weight increase attributed to a "return to health" event. Starting cART before the INsTI era led to weight increase ranging from 1.8 to 2.7 kg in one year and 4.8 kg in 144 weeks [4]. In general, weight increase associated with lower mortality in underweight or normal-weight patients, without benefit for overweight and obese patients due to increased rates of diabetes and cardiovascular disease [5].…”

Section: Integrase Strand Transfer Inhibitor-associated Weight Gainmentioning

confidence: 99%

Potential role of the melanocortin signaling system interference in the excess weight gain associated to some antiretroviral drugs in people living with HIV

et al. 2020

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Exposure to some antiretroviral drugs, especially integrase strand transfer inhibitors (INsTI)-based combination antiretroviral therapy (cART) has been associated with weight gain in people living with HIV (PLWH) exceeding what would be a "return to health" phenomenon. Notwithstanding the fact that weight gain and obesity are multifactorial, the common epidemiological link in PLWH is INsTI-based cART. Here, we postulate that interference with the melanocortin system (MCS) functioning by INsTI plays an essential role in excess weight gain and obesity in PLWH, similar to disturbances caused by melanocortin receptor (MCR) mutations in the general population and by antipsychotic therapy in psychiatric patients.

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A Randomized Comparison of Anthropomorphic Changes With Preferred and Alternative Efavirenz-Based Antiretroviral Regimens in Diverse Multinational Settings

Abstract: Compared to 3TC/ZDV+EFV (N=519), participants randomized to FTC/TDF+EFV (N=526) experienced significantly greater increases in weight, mid-arm, mid-thigh, waist, and hip circumferences, and no lipoatrophy cases. 38-42% of participants in both arms were overweight/obese at 144 weeks.

Cited by 23 publications

References 32 publications

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

Fat Matters: Understanding the Role of Adipose Tissue in Health in HIV Infection

Potential role of the melanocortin signaling system interference in the excess weight gain associated to some antiretroviral drugs in people living with HIV

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