No overall impact on rate of weight gain with integrase inhibitor‐containing regimens in antiretroviral‐naïve adults

Burns, James E.; Stirrup, Oliver; Waters, Laura; Dunn, David; Gilson, Richard; Pett, Sarah

doi:10.1111/hiv.13186

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…In our real‐world cohort, we did not observe a change in the rate of age‐ and sex‐matched BMI‐standardized z score after starting an ART regimen containing dolutegravir. These results are in line with the findings of several adult [3,4] and paediatric cohorts and trials [9,11] but contrast with some other studies [1,2,6–8]. Some HIV‐ and ART‐related factors associated with weight gain in adult randomized clinical trials were absent in most of our subjects, such as low baseline CD4 cell count, high baseline HIV RNA, and ART regimen containing tenofovir alafenamide [2].…”

Section: Discussionsupporting

confidence: 90%

“…Some studies in both naïve and ART-experienced adults suggested that INSTI-based regimens appeared to cause more weight gain and treatmentemergent obesity than non-INSTI combinations [1,2]. By contrast, no clear evidence of an overall increase in rate of weight gain following INSTI initiation was found in other observational adult cohorts [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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No overall impact on body mass index for age change after dolutegravir initiation in a French paediatric cohort

et al. 2022

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Objectives: Increased weight gain with dolutegravir use is increasingly scrutinized in adults, but published data in paediatrics are limited and conflicting. This study aimed to provide long-term data about changes in body mass index (BMI) in French children (aged 3-9 years) and adolescents (aged 10-17 years) receiving dolutegravir. Patients and methods: This retrospective monocentric study included 97 subjects who received a dolutegravir-based regimen for ≥12 months in 2014-2021. We evaluated the mean change in age-and sex-matched standardized BMI z score (BMIz) per year of dolutegravir exposure and compared the dynamics of BMIz change during the 12 months pre-vs. post-dolutegravir use when these data were available. Results: At the time of dolutegravir initiation, most of the subjects were antiretroviral therapy (ART) experienced (89.7%), displayed virological suppression (73.2%), and had normal weight for their age (78.4%). Median follow-up was 30 months (interquartile range [IQR] 19-45). The mean rate of change in BMIz was +0.03 z score/year of dolutegravir exposure (95% confidence interval [CI] −0.08-0.13) in the entire cohort. It was lower in children than in adolescents (−0.08 [95% CI −0.23-0.08] vs. +0.16 [95% CI 0.06-0.26], respectively; p = 0.04) and in individuals with baseline BMI ≥50 th percentile than in those with lower BMI (−0.06 [95% CI −0.14-0.01] vs. +0.08 [95% CI −0.07-0.23], respectively; p = 0.001). Trajectories of BMIz change 12 months pre-vs. post-dolutegravir were similar, except in subjects with baseline BMI ≥50 th percentile, whose rate of BMIz change was lower post-dolutegravir (difference: −0.23 [95% CI −0.46-0.00]; p = 0.04). Conclusion:We found no evidence of change in BMIz in French children initiating dolutegravir. These reassuring findings maintain the primary position of dolutegravir among paediatric therapeutic options.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

No overall impact on body mass index for age change after dolutegravir initiation in a French paediatric cohort

et al. 2022

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“…In these studies, greater weight gain and BMI changes were observed with INSTIs compared to both NNRTIs and PIs, although some noted similar weight trends between INSTI and PI therapy (Table 1). [9][10][11]19,45,46 Overall, the degree of weight changes on INSTI-based therapy were similar between prospective and retrospective studies in treatment-naïve patients. Typical weight changes Weight changes with INSTIs within a dual-therapy regimen have also been evaluated.…”

Section: Weight Change Comparisons Between Instis and Other Art Classesmentioning

confidence: 69%

Section: Data Synthesismentioning

confidence: 99%

Weight Changes With Integrase Strand Transfer Inhibitor Therapy in the Management of HIV Infection: A Systematic Review

2022

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Objective: To describe weight changes with integrase strand transfer inhibitor (INSTI) therapy. Data Sources: A literature search was performed (through December 15, 2021) using the PubMed and CINAHL databases using the search terms: “integrase inhibitors,” “integrase strand transfer inhibitors,” and “weight.” Study Selection and Data Extraction: Studies were included that provided relevant information on weight or body mass index (BMI) changes on INSTI therapy. Controlled or observational studies comparing different INSTI therapies or compared INSTI therapy to another class of antiretroviral therapy were included. Data Synthesis: Forty-three articles met criteria for inclusion, and data are presented. Although some trials have observed similar weight gains between INSTI, protease inhibitor, and non-nucleoside inhibitor therapies, the increase appears to be greater with INSTI therapy, particularly during initiation of therapy. Risk factors for weight gain with INSTI therapy include female gender, lower CD4 count, and combined use of tenofovir alafenamide. Within the INSTI class, dolutegravir and bictegravir appear to have the greatest propensity for weight gain. Relevance to Patient Care and Clinical Practice: INSTI-based therapies are the preferred initial management of HIV infection. Discerning the factors contributing to weight changes on INSTI therapy and risks of associated health-related outcomes is important to both the management of weight gain and HIV medical management. Conclusions: Within the INSTI class, dolutegravir and bictegravir may be associated with the greatest risk for weight gain particularly when combined with tenofovir alafenamide. Further research is needed to determine mechanisms for observed weight changes and any contributions to clinically significant metabolic and cardiovascular adverse outcomes associated with INSTI therapy.

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“…INSTIs were implicated as risk factors for weight gain in other observational studies as well [41,46], with very few reports reporting no association [47].…”

Section: Class Effects and Particular Antiretroviralsmentioning

confidence: 98%

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

Sapuła

Suchacz

Załęski

et al. 2022

Viruses

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The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980’s. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

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No overall impact on rate of weight gain with integrase inhibitor‐containing regimens in antiretroviral‐naïve adults

Cited by 8 publications

References 14 publications

No overall impact on body mass index for age change after dolutegravir initiation in a French paediatric cohort

No overall impact on body mass index for age change after dolutegravir initiation in a French paediatric cohort

Weight Changes With Integrase Strand Transfer Inhibitor Therapy in the Management of HIV Infection: A Systematic Review

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

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