Real-World Assessment of Weight Change in African American Females and Hispanics with HIV-1 After Initiating Integrase Strand-Transfer Inhibitors or Protease Inhibitors

Abstract

Background: Studies have shown an increase in weight among people living with HIV (PLWH) who initiated integrase strand transfer inhibitors (INSTI). However, weight gain with INSTI-based regimens vs other regimens in females or racial/ethnic minorities is poorly understood. Objective: This study assessed differences in weight gain among treatment-naïve, female, African Americans and Hispanics after initiating INSTI-based vs protease inhibitor (PI)-based regimens. Methods: This retrospective, observational cohort study included data from the Optum® deidentified Electronic Health Record Database. Female African Americans or Hispanics initiating INSTI- or PI-based regimens between January 1, 2015, and December 31, 2018 (first prescription was index date), with ≥12-month baseline and follow-up periods, ≥1 weight measure during each period, and no prior antiretroviral (ARV) use were included. Inverse probability of treatment weighting was used to reduce selection bias and improve cohort comparability. Multivariable models were used to compare absolute weight/body mass index (BMI) changes and proportion of patients with weight/BMI increases from pre- to post-index (last measure between the 4th and 12th months post-index). Results: Weighted cohorts included 3407 African American females (INSTI, 1704; PI, 1703) and 3711 Hispanics (INSTI, 1865; PI, 1846) PLWH. Mean time to follow-up weight measure was ~9.5 months. Among female African Americans, INSTI initiators had a 1.5 kg greater mean weight gain (2.1 kg vs 0.6 kg; P = 0.033), and a higher proportion with ≥5% weight gain (32% vs 29%; odds ratio [OR]=1.2; 95% CI [1.0-1.4]) than PI initiators. Among Hispanics, INSTI and PI initiators had similar mean increases in weight (2.1 and 1.8 kg, respectively), but INSTI initiators had a higher proportion with ≥5% weight gain (31% vs 27%; OR=1.2; 95% CI [1.1-1.4]). Female African American INSTI initiators were more likely to shift from normal or overweight to a worse BMI classification. Hispanic INSTI initiators were less likely to shift from normal BMI to overweight but more likely to shift from normal or overweight to obese. Conclusion: In a real-world setting, INSTI-based regimens were associated with greater weight gain for treatment-naïve female African Americans, compared with PI-based regimens. Differences between regimens were less consistent for Hispanics. These results may inform ARV choice for PLWH who are at risk for ARV-related weight gain.

Re-evaluating the relationship between youth with HIV and BMI in an age of increasing rates of overweight and obese youth

“…Thus, while these studies demonstrated a relationship between weight gain and INSTI use, potential confounders including age, initial BMI, CD4 count, HIV viral load, gender and ethnicity can influence this relationship [ 12 , 13 , 16 , 21 – 24 ]. For instance, several studies investigating the effects of ART in PWH have observed a heightened risk of weight gain after the initiation of ART in women PWH [ 15 , 23 – 27 ].…”

Real-Life Experience on Dolutegravir and Lamivudine as Initial or Switch Therapy in a Silver Population Living with HIV

“…These data are reassuring, considering that among INIs, DTG is the most involved in weight gain [ 46 ]. However, we would underline that our cohort of patients involved predominantly white males, whereas integrase inhibitor-related weight gain was more frequently observed in females and those from a black African background among PLWH [ 47 , 48 ].…”

Association Between Weight Gain and the Incidence of Cardiometabolic Conditions Among People Living with HIV-1 at High Risk of Weight Gain Initiated on Antiretroviral Therapy

“…While the aforementioned studies have looked specifically at T2DM risk, many studies have assessed purely ART-associated weight change. As an example, a recent study showed that ART was associated with weight and BMI gain after initiating treatment, along with a significantly greater mean weight gain (1.5 kg) in Black female PLWH who initiated an INSTI compared to a PI over a mean follow-up of 9.5 months [ 30 ]. Findings in Hispanic PLWH also trended in the same direction [ 30 ].…”

“…As an example, a recent study showed that ART was associated with weight and BMI gain after initiating treatment, along with a significantly greater mean weight gain (1.5 kg) in Black female PLWH who initiated an INSTI compared to a PI over a mean follow-up of 9.5 months [ 30 ]. Findings in Hispanic PLWH also trended in the same direction [ 30 ]. The importance of the results of this current study is that they bridge the gap between research like the one just mentioned above, which is investigating ART and weight gain, by isolating the impact of ART-associated weight gain on cardiometabolic outcomes.…”