Weight changes after first-line antiretroviral initiation in a cohort of HIV-positive patients in Southern Spain (CAPOTA study)

Abstract

Background Obesity among persons living with HIV (PLWH) has increased and weight gain after antiretroviral therapy (ART) can lead to metabolic disorders and impact survival. Our objective was to analyze weight and metabolic changes in HIV näive patients after 48 weeks of ART. Methods Observational, retrospective, multicentered cohort study comprising naïve-patients who started tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) or abacavir/lamivudine/dolutegravir (ABC/3TC/DTG), with no change in treatment for 48 weeks. Clinical and metabolic parameters were collected at baseline and week-48. Statistical program used was SPSS 21.0.0. Results The study included 329 participants from 6 hospitals. Participants were 89% male and 10% had AIDS diagnosis. Median age was 35 (IQR 27–43) years. Median baseline CD4 count was 417 (IQR 250–569) cell/mm3 and HIV viral load 4.65 (IQR 4.21–5.18) log10 copies/ml. Baseline median weight was 70 (IQR 62–79) kg, body mass index 23.4 (IQR 21.2–26.0) kg/m2; 22.7% overweight and 6.4% obese. ART regimens: ABC/3TC/DTG (196), TAF/FTC/EVG/c (133). Baseline characteristics were similar in both ART groups. Average weight gain at week-48 was 2.9 (SD 5.5) kg ( p < 0.0001) with no differences between both groups. There was an increase in obesity (6.4%–8%; p < 0.003) and overweight (22.7%–28.9%; p < 0.0001). Weight increase was associated with AIDS: OR 3.05 (95%; CI 1.009–9.22), p = 0.048; and lower baseline weight: OR 1.032 (95% CI 1.009–1.05), p = 0.006. Conclusions After ART initiation patients gain weight regardless of the regimen they take. Weight gain is associated with AIDS and the use of TAF/FTC/EVG/c.

GLP‐1 agonists for people living with HIV and obesity, is there a potential?

“…Similar to the general population, people living with HIV are exhibiting a continuous growth in the trends of obesity. Studying obesity mechanisms and prevention in people with HIV is challenging due to the complex nature of obesity itself, and the proven contribution of some first-line antiretrovirals (ARVs) in promoting weight gain in people with HIV [1,2]. Pooled analysis from the USA and Canada with over 14 000 individuals with HIV demonstrated that 22% of normal-weight patients became overweight, and 18% of overweight patients became obese over 3 years after ARV initiation [3].…”