Brief Report: Weight Gain in Persons With HIV Switched From Efavirenz-Based to Integrase Strand Transfer Inhibitor-Based Regimens.

Abstract

BACKGROUND:

With the introduction of integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy, persons living with HIV have a potent new treatment option. Recently, providers at our large treatment clinic noted weight gain in several patients who switched from efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) to dolutegravir/abacavir/lamivudine (DTG/ABC/3TC). In this study, we evaluated weight change in patients with sustained virologic suppression who switched from EFV/TDF/FTC to an INSTI-containing regimen.

METHODS:

We performed a retrospective observational cohort study among adults on EFV/TDF/FTC for at least 2 years who had virologic suppression. We assessed weight change over 18 months in patients who switched from EFV/TDF/FTC to an INSTI-containing regimen or a protease inhibitor (PI)-containing regimen versus those on EFV/TDF/FTC over the same period. In a subgroup analysis, we compared patients switched to DTG/ABC/3TC versus raltegravir- or elvitegravir-containing regimens.

RESULTS:

A total of 495 patients were included: 136 who switched from EFV/TDF/FTC to an INSTI-containing regimen and 34 switched to a PI-containing regimen. Patients switched to an INSTI-containing regimen gained an average of 2.9 kg at 18 months compared with 0.9 kg among those continued on EFV/TDF/FTC (P = 0.003), whereas those switched to a PI regimen gained 0.7 kg (P = 0.81). Among INSTI regimens, those switched to DTG/ABC/3TC gained the most weight at 18 months (5.3 kg, P = 0.001 compared with EFV/TDF/FTC).

CONCLUSION:

Adults living with HIV with viral suppression gained significantly more weight after switching from daily, fixed-dose EFV/TDF/FTC to an INSTI-based regimen compared with those remaining on EFV/TDF/FTC. This weight gain was greatest among patients switching to DTG/ABC/3TC.

• Authors: Jamison Norwood, Megan Turner, Carmen Bofill, Peter Rebeiro, Bryan Shepherd, Sally Bebawy, Todd Hulgan, Stephen Raffanti, David W Haas, Timothy R Sterling, John R Koethe
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 76 Issue 5 Pg. 527-531 (12 15 2017) ISSN: 1944-7884 [Electronic] United States
• PMID: 28825943 (Publication Type: Journal Article, Observational Study)

Chemical References

• Alkynes
• Benzoxazines
• Cyclopropanes
• HIV Integrase Inhibitors
• Reverse Transcriptase Inhibitors
• efavirenz

Topics

• Adult
• Alkynes
• Benzoxazines (therapeutic use)
• Cohort Studies
• Cyclopropanes
• Female
• HIV Infections (drug therapy)
• HIV Integrase Inhibitors (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Reverse Transcriptase Inhibitors (therapeutic use)
• Weight Gain