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Switch to INI Does Not Affect Average Weight Gain in Middle-Aged/Older Group
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17th European AIDS Conference, November 6-9, 2019, Basel
Mark Mascolini
Middle-aged and older people in the Netherlands AGEhIV cohort who switched to an integrase inhibitor (INI) did not gain more weight, on average, than HIV-positive people who did not switch or than HIV-negative cohort members [1]. But this 595-person comparison found more frequent clinically relevant weight gain (above 5%) in people who switched to an INI.
Prior research documented above-average weight gains in antiretroviral-naive people starting an INI. People switching from other antiretrovirals to an INI have also gained weight, though generally not as much as people starting their first antiretroviral regimen. Researchers working with the AGEhIV cohort in the Netherlands analyzed this population of HIV-positive and negative people to chart weight changes over time with versus without INIs.
AGEhIV includes HIV-positive people at least 45 years old and HIV-negative people similar in age and lifestyle to the HIV group [2]. Since 2010 participants have had standardized weight measurements twice a year. This analysis aimed to compare average and clinically relevant weight gains (more than 5% or more than 10%) in (1) HIV-positive people with an undetectable viral load for at least 1 year on their current antiretroviral regimen and switching to an INI, (2) HIV-positive people with an undetectable viral load not switching their antiretrovirals, and (3) HIV-negative participants.
Researchers matched these groups by age, body mass index, sex, and ethnicity, including 119 people who switched to an INI, 238 who stayed with a nonnucleoside or protease inhibitor, and 238 HIV-negative controls. The INI switch group got weighed before and after the switch, and the other two groups got weighed at least twice. Median ages in the three groups stood at 55, 54, and 53, proportions of men were 87%, 91%, and 84%, and proportions of whites 89%, 89%, and 92%. Median CD4 counts before the switch (or a similar time in nonswitchers) were 640, 630, and 850. The two HIV groups had taken antiretrovirals for a median of 12 years.
Among people who switched to an INI, 53% started dolutegravir, 34% elvitegravir, and 13% raltegravir. Median follow-up measured 1.9 years in the INI-switch group, 2.0 years in nonswitchers, and 3.2 years in HIV-negative people.
A linear mixed-effects model indicated little or no difference between the three study groups in average annual weight change before the switch (or hypothetical switch): 0.11 kg/year in the INI switch group, 0.14 kg/year in nonswitchers, 0.08 kg/year in HIV-negative people. After the switch, average annual changes also proved similar in the three groups: 0.17 kg/year in the switch group, 0.22 kg/year in nonswitchers, and 0.18 kg/year in HIV-negative people. For those three groups, the difference in yearly change before and after the switch measured 0.06, 0.08, and 0.09 kg/year. Between-group kg/year comparisons of nonswitchers and HIV-negative people with the INI-switch group revealed almost no difference.
Despite these overall similarities in weight change across the three groups, a higher proportion of INI switchers gained more than 5% in weight (24%) than did nonswitchers (13%, P = 0.012) or HIV-negative controls (12%, P = 0.004). But only small proportions of each group gained more than 10% in weight: 5% of the INI-switch group, 3% of nonswitchers, and 3% of HIV-negative controls (comparisons not significant).
Among 6 people who gained more than 10% in weight after switching to an INI, 3 were black women, 3 were nonblack men, 4 switched to dolutegravir, and 2 switched to elvitegravir.
The AGEhIV investigators noted that their study is limited by the low number of black and female participants, the limited number of weight measurements after the switch, and the lack of people switching to tenofovir alafenamide (TAF) plus dolutegravir.
References
1. Verboeket S, Boyd A, Wit F, et al. Switching to an integrase inhibitor containing antiretroviral regimen is not associated with above-average weight gain in middle-aged people living with HIV on long-term suppressive antiretroviral therapy, the AGEhIV cohort study. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PS3/6.
2. Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis. 2014;59:1787-1797.
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