Integrase Strand Transfer Inhibitors Play the Main Role in Greater Weight Gain Among Men With Acute and Early HIV Infection

Abstract

Background The predictors of weight gain remain unclear in people with acute and early HIV infection (AEH). Methods Eligible antiretroviral-naïve men diagnosed with AEH from January 1, 2000, to December 31, 2019, were enrolled in an observational cohort study at the University California, San Diego. The study used multivariable mixed-effect linear regression models to analyze differences in the rate of weight gain over time between participants receiving early vs deferred antiretroviral therapy (ART) treatment, low vs high baseline CD4 count and HIV RNA, and different classes of ART. Results A total of 463 participants were identified, with mean CD4 cell count of 507 cells/μL and log HIV RNA of 5.0 copies/mL at study entry. There was no difference in the rate of weight gain between participants who did and did not receive ART within 96 weeks of incident HIV infection. Neither a baseline CD4 count of <350 cells/μL nor a baseline HIV RNA of >100 000 copies/mL was a predictor of weight gain. Compared with persons taking non-nucleoside reverse transcriptase inhibitor–based regimens, those who received integrase strand transfer inhibitor (INSTI)–based regimens showed greater weight gain over time. Conclusions Neither baseline CD4 count and HIV RNA nor early ART was associated with weight change in the first 96 weeks following incident HIV infection. Use of INSTI-based regimens represented a major driver of weight gain in men who initiated ART with relatively higher CD4 cell counts.

Effect of Antiretroviral Therapy on Body Composition in Patients Living with Human Immunodeficiency Virus: An Observational Study

“…Comparisons based on key drugs resulted in higher body fat percentage and visceral fat levels in patients using NNRTI. ARTrelated weight gain has been implicated in low CD4 levels at treatment initiation, blood HIV RNA levels, female sex, and ethnicity [1,[18][19][20]. Various mechanisms regarding ART-related weight gain have been postulated, including the concept of "return to health" at the start of treatment [13].…”

Case Report: Reversal of Integrase Inhibitor– and Tenofovir Alafenamide–Related Weight Gain After Switching Back to Efavirenz/Emtricitabine/Tenofovir DF

“…Integrase strand transfer inhibitor (INSTI)–associated weight gain has been reported in a growing number of recent studies among both treatment-naïve and treatment-experienced patients [ 6–9 ]. An analysis of 8 randomized controlled clinical trials of ART-naïve PWH found that INSTI-containing regimens were associated with more weight gain than NNRTI- and PI-based ART regimens [ 10 ].…”

Current co-morbidities burden in patients living with HIV in low- and middle-income countries

“…DTG is a highly potent HIV integrase inhibitor that is recommended for first-line antiretroviral treatment in all major treatment guidelines. Treatment with DTG resulted in weight gain for participants in two large clinical trials in SSA and was especially pronounced when DTG was combined with the new formulation of tenofovir (tenofovir alafenamide fumarate, TAF) [29,30 ▪ ,31]. For instance, participants in the NAMSAL trial in Cameroon, in a DTG regimen gained a median of 5 kg compared with a 3 kg gain in the efavirenz arm over 48 weeks [31].…”