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

Abstract

Weight and body mass index (BMI) change was assessed among women after switch to integrase inhibitors (INSTIs) and/or tenofovir alafenamide (TAF). From 2006 to 2019, 1,458 women living with HIV enrolled in the Women's Interagency HIV Study and on antiretroviral therapy (ART) with ‡1 study visit before and after switching to INSTIs and/or TAF were included. Weight and BMI were compared pre-and postswitch to INSTI (by class and type) and/or TAF using multivariable linear mixed effects models; all models were also stratified by preswitch presence or absence of obesity (BMI ‡30 vs. <30 kg/m 2 ). Mean age preswitch was 47 -6 years, 64% were black, mean CD4 = 475 -201 cells/mm 3 , 56% had HIV RNA <200 copies/mL, 36% switched to TAF but not INSTI, 60% to INSTI but not TAF, and 3.5% to TAF+INSTI. Time from pre-to postswitch was 12.8 -11.8 months. The INSTI-only group but not TAF groups had small but significant increases in weight and BMI: mean 79.2-80.6 kg and 30.2-30.7 kg/m 2 , p's < .001, respectively, with congruent findings by INSTI type ( p's £ .01). In stratified (preswitch BMI) analyses, only nonobese subgroups experienced increases in weight and BMI across all ART treatment groups ( p's < .05). Significant, although small-to-medium, increases in weight and BMI occurred among nonobese women who switched to INSTIs and/or TAF over short follow-up. Given long-term health consequences of obesity particularly as a low-grade inflammatory condition, identifying women at highest risk of ART-associated weight gain is imperative.

Midlife Body Mass Index, Central Adiposity and Neuropsychological Performance Over 10 Years in Women with and Without HIV Infection

“…Furthermore, almost one-third of women (30% of WLWH, 30% of HIV-) had clinically-relevant depressive symptoms (28-33). Among WLWH, certain antiretroviral therapies (ARTs) may cause body weight gain and/or body fat redistribution and potentially in uence NP (34)(35)(36) and increase the vulnerability of WLWH to cognitive decline.…”

Weight gain stopping/switch rules for antiretroviral clinical trials

“…Findings reported greater weight gain in patients treated with dolutegravir compared to efavirenz in clinical trials in Africa: leading to concerns about longterm effects of obesity with lifelong antiretroviral therapy (ART) [4,5]. Furthermore, recent studies (2021) have reported an association between weight gain and dolutegravir in PHIV, most often in Black ethnic groups and women [6,7]. Although the mechanisms whereby dolutegravir cause weight gain remain unclear; it is hypothesized that the weight gain may be multifactorial in nature: with genetic predisposition, HIV-related factors, the 'return to health' weight gain and demographic factors all contributing.…”

Commentary on Lahiri et al. Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV

“…Among women living with HIV (WLWH), increases in body weight and body mass index (BMI, kg/m 2 ) have been observed after switching to the antiretroviral therapies (ART) - Integrase Inhibitors (INSTI) and/or Tenofovir Alafenamide (TAF) [ 1 , 2 ]. This has broad implications for the HIV aging process and occurrence of later-life disease.…”

“…Consequently, we can expect more ART-related cardiovascular and cerebrovascular sequelae, as well as polypharmacy to control both HIV infection and vascular risk. The paper by Lahiri, et al [ 1 ] offers insights into the role of ART, specifically INSTI and TAF, on simple clinical measures of body weight and BMI.…”

“…The paper by Lahiri, et al [ 1 ] elicits several questions when considering overweight and obesity in relation to brain health. Over a follow-up period of 1–2 years, WLWH experienced body weight and BMI increases of 1–5 kg and 1–2 kg/m 2 , respectively.…”