Long-term weight gain after initiating combination antiretroviral therapy in treatment-naïve Asian people living with human immunodeficiency virus

Ando, Naokatsu; Nishijima, Takeshi; Mizushima, Daisuke; Inaba, Yosuke; Kawasaki, Yohei; Kikuchi, Yoshimi; Oka, Shinichi; Gatanaga, Hiroyuki

doi:10.1016/j.ijid.2021.07.030

Cited by 23 publications

(18 citation statements)

References 23 publications

(35 reference statements)

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“…Focusing on the reasons to start PIs, the main cause was adverse effects to previous treatment (43% of patients included in our study), mainly CNS and gastrointestinal toxicity caused by INSTIs. These results are in line with those of several other studies which reported that INSTIs are related with sleeping orders and weight gain, although they are recommended as rst-choice because of their safety pro le 5,6,11,12 .…”

Section: Discussionsupporting

confidence: 92%

“…In this way, regimens that previously were considered priority schemes are now used when patients do not respond to INSTIs or when toxicity appears. Regarding safety, despite INSTIs have a positive toxicity pro le, some adverse events have been reported with their use, such as neuropsychiatric events and metabolic issues 5,6 . Because of that, some patients' optimal ART are not INSTIs and clinicians are required to choose another regimen.…”

Section: Introductionmentioning

confidence: 99%

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Real-World Study of HIV Patients Starting Antiretroviral Treatment With Boosted Protease Inhibitors in the Integrase Inhibitors Era

Pardo¹,

Salillas²,

Jiménez-Nácher³

et al. 2022

Preprint

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Background Boosted-protease inhibitors (b-PIs) are not recommended for initial therapy in HIV patients, but there is still a cohort of patients who could benefit from this antiretroviral treatment (ART). The purpose of this study was to analyze the profile of HIV patients who receive for the first time an ART containing two nucleoside reverse transcriptase inhibitors (NRTIs) and one b-PI. Efficacy and safety of this treatment, as well as the reasons for starting and changing it, were evaluated. Methods An observational, retrospective study was performed on the use of b-PIs in adult HIV patients. Individuals who started treatment with two NRTIs (emtricitabine and tenofovir alafenamide) and one b-PI (darunavir combined with cobicistat or ritonavir) between October 2019 and September 2021 were eligible for our study. This study was retrospectively registered by local Ethics Committee of our hospital (protocol number: PI-5066) on January 13th 2022. Results Overall, 52 patients started ART with two NRTIs plus one b-PIs. Only 8% of them were naïve, 21% received already two NRTIs plus a b-PI and 71% received other regimens. Reasons to start PIs were adverse effects to previous treatment and previous treatment failure. Most patients continued PIs treatment during the 2 years follow-up period and only six of them withdrew it. Conclusions This study analyzes the subgroup of patients that could benefit from treatment with b-PIs in the current era of integrase inhibitors. Even though its use is minority, its efficacy is high especially in patients with toxicity, therapeutic failure or poor adherence to other ARTs.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Real-World Study of HIV Patients Starting Antiretroviral Treatment With Boosted Protease Inhibitors in the Integrase Inhibitors Era

Pardo¹,

Salillas²,

Jiménez-Nácher³

et al. 2022

Preprint

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Section: Weight Gain and Artmentioning

confidence: 99%

“…There are few reports on the effects of ART on weight gain in Asian PLWH [ 46 47 ]. A Japanese retrospective observational study evaluated ART-associated weight gain in adult treatment-naïve Asian PLWH for 5 years following treatment initiation [ 47 ]. Five years after treatment initiation, the average weight gain among PLWH who were started on dolutegravir-, darunavir-, and elvitegravir-based treatment was 5.3, 4.1, and 4.6 kg, respectively, whereas those started on raltegravir-, lopinavir-, and atazanavir-based treatment gained an average of 1.9, 2.1, and 2.3 kg, respectively.…”

Section: Weight Gain and Artmentioning

confidence: 99%

Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients

Chang

2022

Infect Chemother

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While human immunodeficiency virus (HIV)-associated wasting has declined with significant advances in antiretroviral therapy (ART), weight gain and metabolic syndrome (MetS) are now becoming a problem for people living with HIV (PLWH) worldwide. The development of a new and more effective ART regimen has increased viral suppression and improved immunologic function recovery, leading to the extension of the lifespan of PLWH. It has recently been reported as one of the significant factors associated with weight gain, obesity, and long-term metabolic consequences in PLWH. This article reviewed the epidemiology of overweight and MetS among PLWH and the known risk factors for weight gain and its major comorbidities, such as dyslipidemia, diabetes mellitus, cardiovascular diseases, neurocognitive disorders, and liver diseases, in PLWH. In addition, reports on the pharmacological and surgical management of overweight and obesity in PLWH has been briefly summarized.

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“…Several studies have investigated the association between INSTI use and weight gain. An increasing evidence from randomized and observational studies suggests a correlation between dolutegravir use and an accelerated weight gain [7][8][9]. More limited data are available about weight change associated with bictegravir therapy, but both trials and observational studies suggest an effect comparable to dolutegravir therapy [10,11].…”

mentioning

confidence: 99%

Weight gain in treatment-naive HIV-1 infected patients starting abacavir/lamivudine/dolutegravir or tenofovir alafenamide/emtricitabine/bictegravir

Calza

Borderi

Colangeli

et al. 2022

Aids

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Weight gain in treatment-naive HIV-1 infected patients starting abacavir/lamivudine/dolutegravir or tenofovir alafenamide/emtricitabine/bictegravir Recent evidence suggests that initial combination antiretroviral therapy (cART), including integrase strand transfer inhibitors (INSTIs), is associated with greater weight gain than initial regimens including other antiretroviral classes, and this correlation has led to an increasing concern, because international guidelines recommend the INSTI-based regimens as the preferred first-line treatment for HIV infection [1][2][3].An unexpected excess in weight gain has been reported mostly in the course of dolutegravir-based treatments [3][4][5], but a comparison in weight gain associated with dolutegravir and bictegravir-based cART is still lacking.We performed a retrospective, observational, cohort analysis of HIV-1-infected adult patients naive to antiretroviral therapy and initiating a first antiretroviral treatment in our Division of Infectious Diseases from June 2018 through June 2020. Patients starting the coformulated antiretroviral regimen abacavir/lamivudine/dolutegravir (ABC/3TC/DOL) or tenofovir alafenamide/emtricitabine/bictegravir (TAF/FTC/BIC), and with a follow-up of at least 12 months were enrolled into the study.Demographic, clinical and laboratory data were extracted from the medical records and included weight, BMI, waist circumference, lipids, glucose and insulin. BMI classes were 18 kg/m 2 or less (class I), 18.1-25 kg/m 2 (class II), 25.1-30 kg/m 2 (class III) and more than 30 kg/m 2 (class IV). The homeostasis model assessment-estimated insulin resistance (HOMA-IR) index was calculated multiplying fasting plasma insulin (mUI/l) by fasting plasma glucose (mg/dl), then dividing by the constant 405, and insulin resistance is defined by HOMA-IR more than 2.5 [6].Study inclusion criteria were met by 141 patients who were enrolled in the study: 68 patients starting abacavir/ lamivudine/dolutegravir (ABC/3TC/DOL group) and 73 starting tenofovir alafenamide/emtricitabine/bictegravir (TAF/FTC/BIC group). Demographic, clinical and laboratory characteristics of study patients at baseline were comparable in both groups and are summarized in Table 1.The baseline mean (AE SD) weight was 72.8 (AE 10.7) kg, waist circumference 87.9 (AE 14.9) cm and BMI 24.3 (AE 3.6) kg/m 2 . In detail, BMI was 18 kg/m 2 or less (class I) in eight (5.7%) patients, ranging between 18 and 25 kg/m 2 (class II) in 79 (56%), ranging between 25 and 30 kg/m 2 (class III) in 35 (24.8%), and more than 30 kg/m 2 (class IV) in 19 (13.5%). Patients with baseline HOMA-IR index more than 2.5 were five (7.3%) in ABC/3TC/DOL group and four (5.5%) in TAF/FTC/BIC group.

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Long-term weight gain after initiating combination antiretroviral therapy in treatment-naïve Asian people living with human immunodeficiency virus

Cited by 23 publications

References 23 publications

Real-World Study of HIV Patients Starting Antiretroviral Treatment With Boosted Protease Inhibitors in the Integrase Inhibitors Era

Real-World Study of HIV Patients Starting Antiretroviral Treatment With Boosted Protease Inhibitors in the Integrase Inhibitors Era

Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients

Weight gain in treatment-naive HIV-1 infected patients starting abacavir/lamivudine/dolutegravir or tenofovir alafenamide/emtricitabine/bictegravir

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