Weight and Metabolic Changes After Switching From Tenofovir Alafenamide/Emtricitabine (FTC)+Dolutegravir (DTG), Tenofovir Disoproxil Fumarate (TDF)/FTC + DTG, and TDF/FTC/Efavirenz to TDF/Lamivudine/DTG

Bosch, Bronwyn; Akpomiemie, Godspower; Chandiwana, Nomathemba; Sokhela, Simiso; Hill, Andrew; McCann, Kaitlyn; Qavi, Ambar; Mirchandani, Manya; Venter, W D Francois

doi:10.1093/cid/ciac949

Cited by 38 publications

(29 citation statements)

References 10 publications

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“…Our findings are supported by data from the CHARAC-TERISE study, in which a subset of participants originally randomized to either TAF/FTC/DTG, TDF/FTC/ DTG or TDF/FTC/EFVas part of the ADVANCE study [10] were all switched to TDF/3TC/DTG showing only modest decreases in weight after this switch [11].…”

Section: Discussionsupporting

confidence: 74%

“…Median time between start TAF/INSTI and first recording of at least 7% weight gain was 12 months (IQR [6][7][8][9][10][11][12][13][14][15][16][17][18] and time between first recording of at least 7% weight gain and discontinuation of TAF and/or INSTI was 18 months . This did not differ between groups, when stratified by discontinued agent (Table 1).…”

Section: Study Populationmentioning

confidence: 99%

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No evidence of rapid reversibility of tenofovir alafenamide and/or integrase strand transfer inhibitor-associated weight gain

Verburgh

Wit

Boyd

et al. 2023

Aids

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Objective: We aimed to determine the reversibility of ≥7% weight gain (WG) within 12 months following TAF- and/or INSTI-discontinuation in people with HIV (PWH) from the Dutch ATHENA cohort. Design and methods: PWH with ≥7% WG within 24 months after first switch to TAF and/or INSTI whilst being virally suppressed were selected, excluding those with comorbidities/co-medication known to be associated with WG. PWH who discontinued only TAF, only INSTI or TAF+INSTI, with available follow-up weight, were included. Mean weight change in the 24 months prior to and 12 months after discontinuation was modelled using mixed-effects linear regression. Factors associated with yearly weight change were assessed using linear regression. Results: In 115 PWH, discontinuing only TAF (n = 39), only INSTI (n = 53) or TAF+INSTI (n = 23), the adjusted mean modelled weight change in the 24 months prior to discontinuation was +4.50 kg [95%CI, 3.04–6.10], +4.80 kg [95%CI, 2.43–7.03] and +4.13 kg [95%CI, 1.50–7.13], respectively, and -1.89 kg [95%CI, -3.40 to -0.37], -1.93 kg [95%CI, -3.92 to +0.07] and -2.55 kg [95%CI, -5.80 to +0.02] in the 12 months post-discontinuation. A greater number of years since HIV diagnosis was associated with greater reversibility of WG. No associations were found between weight change post-discontinuation and changes in NRTI backbone or anchor agent at moment of discontinuation. Conclusions: There was no evidence of rapid reversibility of ≥7% TAF- and/or INSTI-associated WG after discontinuation of these agents. Studies of larger and more diverse populations of PWH are required to more fully understand the degree to which WG is reversible when discontinuing TAF and/or INSTI.

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Section: Discussionsupporting

confidence: 74%

Section: Study Populationmentioning

confidence: 99%

No evidence of rapid reversibility of tenofovir alafenamide and/or integrase strand transfer inhibitor-associated weight gain

Verburgh

Wit

Boyd

et al. 2023

Aids

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“…12 Recent studies of switch from EFV to DTG while maintaining other ART components have ranged from a mean 1-year weight gain of 1.1 kg in Zambia 10 to 2.9 kg, nearly 3-fold greater, in South Africa. 11 With recent widespread transition to DTG/TDF/3TC, it is important to understand effects on weight and metabolic disease across different populations and contexts throughout sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

“…10 Another study in South Africa showed that switch from TAF to TDF resulted in weight loss in women, but not in men, highlighting potential sex-specific effects. 11 Switch from EFV to DTG also may also lead to weight gain, albeit with variable effects in different populations that could be due to heterogeneity in food environment or genetic polymorphisms affecting drug metabolism. 12 Recent studies of switch from EFV to DTG while maintaining other ART components have ranged from a mean 1-year weight gain of 1.1 kg in Zambia 10 to 2.9 kg, nearly 3-fold greater, in South Africa.…”

Section: Introductionmentioning

confidence: 99%

Weight Change Following Switch to Dolutegravir for HIV Treatment in Rural Kenya During Country Roll-Out

Hickey

Wafula²,

Ogachi³

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…(7) Blood pressure rises with age, so any monitored cohort will see a natural rise. (8) Even if there is a difference in the risk of hypertension between dolutegravir and efavirenz, or between TAF and TDF-based treatment [31], this may not be sufficient reason to change treatment. Hypertension can be monitored and treated using cheap generic drugs.…”

Section: Issues With Interpretation Of Hypertension In Clinical Trialsmentioning

confidence: 99%

Clinical consequences of weight gain during treatment for HIV infection

Hill,

Venter

2023

Current Opinion in HIV and AIDS

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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.

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Weight and Metabolic Changes After Switching From Tenofovir Alafenamide/Emtricitabine (FTC)+Dolutegravir (DTG), Tenofovir Disoproxil Fumarate (TDF)/FTC + DTG, and TDF/FTC/Efavirenz to TDF/Lamivudine/DTG

Cited by 38 publications

References 10 publications

No evidence of rapid reversibility of tenofovir alafenamide and/or integrase strand transfer inhibitor-associated weight gain

No evidence of rapid reversibility of tenofovir alafenamide and/or integrase strand transfer inhibitor-associated weight gain

Weight Change Following Switch to Dolutegravir for HIV Treatment in Rural Kenya During Country Roll-Out

Clinical consequences of weight gain during treatment for HIV infection

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