Clinical consequences of weight gain during treatment for HIV infection

Abstract

Purpose of review The introduction of dolutegravir, an oral integrase inhibitor, within public health HIV programs has been a success, with excellent sustained viral load suppression, persistence, and safety. Initial concerns around integrase-inhibitors being implicated in safety concerns around immune reconstitution inflammatory syndromes (IRIS), neural tube defects, and weight gain, have been largely laid to rest, but new concerns about cardiovascular risk have arisen, including a link between hypertension and this antiretroviral class. Recent findings We review the pertinent studies here, and while we find both observational and randomized controlled study associations in some but not all studies, these are often confounded by associated weight gain and aging. In addition, definitions of hypertension, as well as measurement within the studies (such as cuff size), were not consistent within studies. Summary Careful analysis will be needed, as with the weight-gain signal, before assigning causation, especially as plausible physiological mechanisms for this rise in blood pressure are unclear.

Blood pressure increases are associated with weight gain and not antiretroviral regimen or kidney function: a secondary analysis from the ADVANCE trial in South Africa

“…The NAMSAL trial found comparable rates of treatment‐emergent hypertension but greater differences in BP changes between arms. We hypothesize that differences between our analysis and the NAMSAL trial may have been due to higher rates of hypertension treatment in the ADVANCE cohort, differences in the extent of weight gain in South Africa compared to Cameroon and inclusion of a TAF‐containing arm in ADVANCE [ 31 ]. Ultimately, however, the lack of consensus in this literature suggests a need for additional research to clarify these relationships, including in other clinical trial populations and in other settings.…”