Risk Factors for Weight Gain Following Switch to Integrase Inhibitor–Based Antiretroviral Therapy

Clinical Infectious Diseases, February 2020

Research suggests that integrase strand transfer inhibitors (INSTIs) are associated with greater weight gain compared to other HIV medications. In order to gain further insights into this issue, Lake and colleagues looked at data from participants enrolled in A5001 and A5322 (studies providing long-term follow-up of people previously enrolled in ACTG randomized clinical trials) from 1997-2017 who switched to an INSTI. They assessed weight gain per year, before and after the switch, taking into account other important variables including age, sex, race/ethnicity, baseline body mass index (BMI), lowest CD4+ T cell count, smoking, diabetes and follow-up time with suppressed (<200 copies/mL) HIV-1 viral load. The study population included 972 adults who switched to INSTI, 81% male and 50% non-white. Median age at switch was 50 years, CD4+ T cell count 511 cells/uL and BMI 26.4 kg/m2.

DACS 348/1 found that among virally suppressed participants, those who were women, Black or 60 years or older, gained more weight in the two years after they switched to INSTI compared to the two years prior. After adjusting for the variables described above, being white or Black, 60 years or older and obese (BMI >30 kg/m2) were associated with greater weight gain following the switch to INSTI among women. Being 60 years or older was the greatest risk factor for men.

Editor’s Clinical Impact Statement: This information adds to the growing body of evidence that INSTIs are associated with weight gain. The amount of weight in each person varies and there are many benefits to using this class of anti-HIV medicine. We still need to learn more about this issue.

Lake, J. E., Wu, K., Bares, S. H., Debroy, P., Godfrey, C., Koethe, J. R., McComsey, G. A., Palella, F. J., Tassiopoulos, K., & Erlandson, K. M. (2020). Risk Factors for Weight Gain Following Switch to Integrase Inhibitor-Based Antiretroviral Therapy. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 71(9), e471–e477.