Weight gain is common after initiating or switching antiretroviral therapy
Presenter: Olivier Robineau, University of Lille, Gustave Dron Hospital, Tourcoing, France
A recent study determined that treatment-naïve as well as treatment-experienced HIV-positive individuals gain weight in the 12 months following initiation of or switch in antiretroviral therapy (ART), with an average weight gain slightly greater than the general population that varies by treatment status, third agent, backbone regimen, and preswitch backbone regimen.
In the analysis, 2,666 HIV-positive participants from four postauthorization observational cohort datasets (2010 to 2020) experienced mean weight gain over 12 months of 2.7 kg in treatment-naïve and 1.4 kg in treatment-experienced participants. By comparison, expected average weight gain in the general adult population is 0.5 to 1.0 kg per year,1 according to lead investigator Olivier Robineau, infectious disease specialist, University of Lille, Gustave Dron Hospital, Tourcoing, France.
Weight and body mass index (BMI) data were collected at baseline (< 14 days from treatment initiation) and over 12 months of follow-up on participants receiving integrase strand transfer inhibitor (INSTI)-based or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART regimens as third agents. 727 participants were treatment-naïve, and 1,939 were treatment-experienced. All received either emtricitabine (F)/ tenofovir alafenamide (TAF), or F/ tenofovir disoproxil fumarate (TDF) as backbone. Treatment-experienced participants had either switched to F/TAF from an F/TDF or abacavir (ABC)/ lamivudine (3TC) backbone or did not switch, remaining on an F/TAF or F/TDF backbone.
At baseline, in the treatment-naïve group, 86% of the NNRTI recipients received F/TDF as their backbone while 84% of the INSTI recipients had T/TAF as their backbone. In the treatment-experienced group, 48% of NNRTI recipients had F/TDF as their backbone, and 91% of INSTI recipients had F/TAF as their backbone regimen. About half in the treatment-experienced group who had F/TDF as their backbone switched to F/TAF, and 3% of those who received an NNRTI and 12% who received an INSTI switched from ABC/3TC as their backbone to F/TAF.
A linear mixed model accounting for age, sex, backbone regimen, backbone switch, HIV-1 RNA, and height was used to predict longitudinal mean weight and BMI over 12 months based on average population.
Mean weight increased from 74.8 kg at baseline to 77.5 kg at 12 months in the treatment-naïve participants, and from 76.6 to 78.0 kg in treatment-experienced participants.
At baseline, 6% of treatment-naïve participants were classified as obese by BMI and 24% as overweight, which increased to 9% and 30%, respectively, at 12 months. In the treatment-experienced group, 10% were classified as obese and 31% as overweight at baseline, compared with 12% and 34%, respectively, at 12 months.
Regarding the third agent, “treatment-naïve people living with HIV who received F/TDF had a slightly steeper slope of weight gain if they received INSTI versus NNRTI,” said Dr. Robineau.
“Treatment-experienced participants who received F/TDF had similar weight change trajectories over 12 months, regardless of third agent.”
Similarly, treatment-naïve participants who were treated with F/TAF had a steeper slope of weight gain if they received INSTI versus NNRTI as their third agent, whereas the treatment-experienced group treated with F/TAF had similar weight change trajectories over 12 months regardless of their third agent. At 12 months, treatment-naïve patients on F/TAF had a smaller weight increase when receiving an NNRTI versus an INSTI as third agent (1.6 vs. 3.4 kg).
Among the treatment-experienced patients, participants in both the INSTI and NNRTI groups who switched their backbone from F/TDF to F/TAF had a greater increase in weight (+1.9 kg) compared with those who did not switch (+1.4 kg) or those who switched from ABC/3TC to F/TAF (+0.7 kg).
These results are consistent with previous data2-4 demonstrating less weight gain with F/TDF regimens, the authors noted.
Disclosures
Dr. Robineau discloses relationships with Gilead Sciences, MSD, and ViiV Healthcare.
References
- Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: where do we go from here? Science 2003; 299(5608):853-855. doi:10.1126/science.1079857
- Gidden DV, Mulligan K, McMahan V, et al. Metabolic effects of preexposure prophylaxis with coformulated tenofovir disoproxil fumarate and emtricitabine. Clin Infect Dis 2018; 67(3):411-419. doi:10.1093/cid/ciy083
- Ogbuagu O, Ruane PJ, Podzamczer D, et al. randomised, double-blind, placebo-controlled, phase 3 trial. Lancet HIV 2021; 8(7):e397-e407. doi:10.1016/S2352-3018(21)00071-0
- Mallon PW, Brunet L, Hsu RK, et al. Weight gain before and after switch from TDF to TAF in a U.S. cohort study. J Int AIDS Soc 2021; 24(4):e25702. doi:10.1002/jia2.25702