Weight Change After Antiretroviral Therapy and Mortality

Yuh, Bianca; Tate, Janet P.; Butt, Adeel A.; Crothers, Kristina; Freiberg, Matthew S.; Leaf, David A.; Logeais, Mary E.; Rimland, David; Rodriguez‐Barradas, Maria C.; Ruser, Christopher; Justice, Amy C.

doi:10.1093/cid/civ192

Cited by 155 publications

(151 citation statements)

References 41 publications

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“…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]. Further exemplifying the fact that weight gain can represent differential effects depending on the host, weight gain among underweight persons has been associated with a decline in circulating high-sensitivity C-reactive protein levels[12] and improved survival[13], whereas weight gain among overweight or obese individuals has been associated with significant increases in circulating levels of the monocyte activation marker soluble CD14[12], no mortality benefit[13] and a ≥67% prevalence of multi-morbidity[14]. …”

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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Section: Introductionmentioning

confidence: 99%

“…1–3 In the early ART era, weight gain on treatment was often seen as evidence of nutritional rehabilitation and associated with improved survival and immunologic recovery. 3–7 However, over the past two decades the BMI of HIV-infected persons on ART has steadily increased, and in one multisite US study over half of patients remaining on treatment at 3 years were overweight or obese. 1,8 Among patients on ART, a high BMI confers an increased risk of developing diabetes, neurocognitive impairment, and other comorbid conditions in HIV-infected persons, and the avoidance of weight gain may reduce these risks.…”

Section: Introductionmentioning

confidence: 99%

“…Prior retrospective cohort studies have demonstrated that weight gain may be more pronounced in patients who were initiated on a PI-based regimen, 2,3,16 and a handful of clinical trials have assessed weight gain in treatment-naive patients initiating INSTI-containing regimens. 17–21 However, there are few data on weight change in patients with effective virologic suppression who switch to an INSTI-containing regimen.…”

Section: Introductionmentioning

confidence: 99%

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Brief Report: Weight Gain in Persons With HIV Switched From Efavirenz-Based to Integrase Strand Transfer Inhibitor–Based Regimens

Norwood

Turner

Bofill

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

230

147

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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.

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“…For example, weight gain among underweight persons has been associated with a decline in high-sensitivity C-reactive protein (hs-CRP)levels, while weight gain among overweight or obese individuals has been associated with a significant increase in soluble CD14 (sCD14) levels (2015 Conference on Retroviruses and Opportunistic Infections, Seattle, WA; Erlandson, et al Abstract 778). Similarly, a recent Veterans Aging Cohort Study analysis observed improved survival with weight gain in the first year of ART among underweight or normal weight but not overweight or obese participants [14]. Furthermore, overweight or obese HIV-infected individuals have a ≥67% prevalence of multi-morbidity [15].…”

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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Weight Change After Antiretroviral Therapy and Mortality

Abstract: The survival benefits of weight gain after ART initiation are dependent on starting BMI. Weight gain after ART is associated with lower mortality for those who are not initially overweight.

Cited by 155 publications

References 41 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

Brief Report: Weight Gain in Persons With HIV Switched From Efavirenz-Based to Integrase Strand Transfer Inhibitor–Based Regimens

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

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