Antiretroviral Therapy Anchor-based Trends in Body Mass Index Following Treatment Initiation Among Military Personnel with HIV

Abstract

Introduction Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the U.S. Military HIV Natural History Study (NHS). Materials and Methods NHS participants with available baseline weight and height data initiating ART from 2006 to 2017 were considered for analysis. Antiretroviral therapy was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI (<25 vs ≥25 kg/m2) at ART start and anchor drug class. These models were adjusted for demographic- and HIV-related characteristics. Results Of 961 NHS participants started on initial ART between 2006 and 2017, 491 men who had available baseline BMI data and were virally suppressed (<200 c/mL) at 1 and 2 years of follow-up were included. Overall, the predicted BMI increased at each time point over 2 years regardless of baseline BMI. There was a trend toward less weight gain for non-INSTI regimens regardless of demographic- or HIV-related factors (−0.65 kg/m2/yr, P = .070). In participants with BMI <25, all regimens were associated with BMI gains except in those with high viral load (≥100,000 copies/mL) started on PI regimens (−1.91 kg/m2/yr, P = .000; n = 13). For those participants with BMI ≥25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54 kg/m2/y, P = .000; PI 0.39 kg/m2/yr, P = .006). Non-nucleoside reverse transcriptase inhibitors were not associated with weight gain regardless of race- or HIV-related characteristics. African Americans with BMI ≥25 were more likely to gain weight as compared to Whites (0.99 kg/m2/yr, P = .016). Specific anchor drug-based predictions revealed that only INSTI use among African Americans was significantly associated with BMI gains (1.85 kg/m2/yr, P = .007); NNRTI- and PI-related weight change was not significant as compared to Whites. Conclusions In our cohort of young military members with HIV infection, those with BMI <25 experienced BMI gains across all ART classes. Among those with BMI ≥25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.

Association of HIV-1 Infection and Antiretroviral Therapy With Type 2 Diabetes in the Hispanic Population of the Rio Grande Valley, Texas, USA

“…Recent studies have suggested that the major classes of ART have differential effects on weight gain (31,(46)(47)(48)(49)(50) and abnormalities in fat and lipid storage (51). For example, Menard et al, reported that there was a mean weight gain of ∼3 kg in a cohort (N = 462) receiving an integrase inhibitor-based ART regimen (dolutegravir) after a follow-up of an average of 276 days (46).…”

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

“…Kline et al found no significant difference in weight gain between regimens among men with baseline BMI <25 kg/m 2 . 31 In contrast, a study from the Women's Interagency HIV Study (WIHS) reported that BMI <30 kg/m 2 was a risk factor for greater weight gain among those using INSTI-based regimens. 22 Similarly, our study found a greater risk of 10%, 20%, or 10 kg weight gain for African American females with baseline BMI <25 kg/m 2 , but not among those with BMI ≥25 kg/m 2 .…”

“…20 Similarly, a recent prospective, observational study by Kline et al of military personnel with HIV reported that overweight African American men initiating INSTI-based regimens had greater mean BMI increase at 2 years than overweight White men (1.85 kg/m 2 /yr, P = 0.007). 31 Lake et al recently reported that among virally suppressed PLWH who switched to INSTI regimens, Black race and female sex were associated with greater weight gain. 28 However, the literature reports inconsistent results regarding baseline BMI as a risk factor for ARV-related or INSTI-related weight gain.…”

Trends in body mass index in the pre-dolutegravir period in South Africa

“…17,18,19 There is ample evidence that PLWH starting INSTI gain significantly more weight compared to PLWH using a firstline ART regimen without INSTI. 10,20,21,22 However, most studies addressing weight gain in people on INSTI-based ART lack comparison with HIV-negative controls, which makes it hard to address excess weight gain compared to the non-HIV-positive population. RCTs conducted in ART-naïve PLWH in Johannesburg, South Africa, and in Yaoundé, Cameroon, showed a significant increase in weight over 96 weeks in people on a dolutegravir-emtricitabine-tenofovircontaining regimen compared to the standard care group receiving a tenofovir disoproxil fumarate and efavirenz-based regimen.…”