978. Changes in BMI Associated with Antiretroviral Regimens in Treatment-Experienced, Virologically Suppressed Individuals Living with HIV

Abstract

BackgroundA potential association between integrase inhibitor (INSTI) use and weight gain has been reported in people living with HIV (PLWH). We examined body mass index (BMI) increases after a switch to dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), rilpivirine (RPV), or boosted darunavir (bDRV) among virologically suppressed ART-experienced PLWH.MethodsART-experienced, suppressed (ART-ES; baseline viral load < 200 copies/mL) PLWH ≥ 18 years of age initiating DTG, EVG/c, RAL, RPV, or bDRV for the first time were identified in the OPERA® cohort. The association between core agents and mean increases in BMI at 6, 12, and 24 months was estimated with multivariable linear regression. Inverse probability-of-censoring weights (IPCW) were used to account for censoring (regimen discontinuation, loss to follow-up, death, pregnancy, or no BMI measured). Analyses were stratified by baseline BMI categories (underweight: <18.5, normal weight: ≥18.5 to <25, overweight: ≥25 to <30, obese: ≥30).ResultsAt baseline, endocrine disorders were reported in >40% of PLWH receiving DTG and RAL; >60% were overweight/obese in all groups (Figure 1). Mean BMI (unadjusted) increased for all ARVs over time, with changes at 24 months ranging from 0.30 (DRV) to 0.83 (RPV, Figure 2). At 6 months, the adjusted mean BMI increase was statistically smaller with EVG/c, RAL, and bDRV (range –0.15 to –0.30) than with DTG (Figure 3); these differences only remained significantly different for bDRV at 12 (–0.29) and 24 months (–0.29, Figure 3). Among those with a normal baseline BMI, the adjusted mean change in BMI at 12 months was smaller with EVG/c, bDRV, and RAL than DTG (range –0.26 to –0.27). Among overweight PLWH, the adjusted mean BMI increase was statistically smaller with bDRV than DTG (–0.32, Figure 4). Results were consistent in IPCW estimates.ConclusionThe majority of PLWH on stable ART in this US-based cohort were overweight/obese at the time of switch to the regimens of interest. Small mean increases in BMI for all regimens were noted over time, for which the clinical significance is not yet known. Apparent differences in BMI changes favoring EVG/c, RAL, and bDRV vs. DTG over the short term were largely attenuated with longer follow-up, with significant differences mainly observed in those with a normal BMI at baseline. Disclosures All Authors: No reported Disclosures.

Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV

“…6 Integrase strand transfer inhibitor (INSTI)-containing ART regimens are the recommended first-line treatment of ARTnaive PLWH due to virologic efficacy and tolerability. 7 Despite excellent safety profiles and low side effect rates in Phase III clinical trials, data from randomized controlled trials and observational studies after widespread use of INSTIs in more diverse populations have shown increases in weight and BMI [8][9][10][11][12][13][14][15][16][17][18] particularly with dolutegravir [9][10][11]14,16,18 and among black and Hispanic women. 9,11 Recently, we showed that women switching to or adding an INSTI to their ART regimen in the pretenofovir alafenamide (TAF) era were more likely to experience clinically significant ( ‡7%) weight gain than women remaining on non-INSTI ART for an 18-month period: 22% versus 14%, with congruent findings across additional adiposity measures.…”

Weight Change and Predictors of Weight Change Among Patients Initiated on Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide or Bictegravir/Emtricitabine/Tenofovir Alafenamide: A Real-World Retrospective Study

“…9,10 While the INSTI class had demonstrated a proven tolerability profile, recent evidence suggests that among treatment-naïve patients or stable patients switching from previous ART, those initiated on an INSTI-based regimen were more likely to experience weight gain than those initiated on other types of ART regimens. [11][12][13][14] Recent DHHS guidelines also highlight that greater weight gain is observed among patients treated with INSTI-based regimens relative to PI-based regimens. 8 Furthermore, INSTI use has been associated with greater risk of metabolic outcomes, including diabetes mellitus.…”