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Improvement in Diet Attenuates Antiretroviral Therapy (ART) Associated Weight Gain in Persons with Human Immunodeficiency Virus (PWH)
Improved Diet Tied to Lower ART-Related Weight Gain in 870-Person US Study
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IDWeek, September 29-October 3, 2021
Mark Mascolini
Self-reported diet lowered chances of weight gain in an 870-person retrospective analysis that also linked tenofovir alafenamide/emtricitabine (TAF/FTC) and integrase inhibitors-especially dolutegravir-to weight gain in this HIV group at the Ohio State University Infectious Diseases Clinic [1]. Two thirds of these study participants taking antiretroviral therapy (ART) had an initial body mass index (BMI) in the overweight/obese range.
Recent research links integrase inhibitors, female gender, and nonwhite race to unwanted weight gain in people taking contemporary antiretrovirals for HIV. Ohio State University researchers planned this single-center retrospective study of adults taking ART to identify factors associated with a 5-kg (11-pound) or greater weight gain over the study period, January 1, 2015 through January 1, 2019.
Participants had to be at least 18 years old, take ART for at least 3 months, and have at least 2 follow-up visits in the study period. The researchers excluded pregnant women, prisoners, people with a cancer history, and people with a CD4 count below 200 cells or a viral load above 200 copies.
The researchers defined diet as "any change a patient made in their oral intake to improve consumption of nutrient-dense foods in efforts to maintain or lose weight." During office visits, clinicians counseled people on diet then recorded whether each person subjectively reported improvements in diet-as just defined-since their last visit.
The 870 study participants averaged 46.3 years in age (+/- 11.7), 83.6% were men, 66.7% white, 29.2% black, and 3.7% Hispanic. Weight averaged 85 kg (l87 pounds), body mass index 27.6 kg/m2 (in the overweight range), and CD4 count 714. Almost everyone, 98.4%, had a viral load below 40 copies.
High proportions of participants took tenofovir disoproxil fumarate (TDF)/FTC (49.6%), abacavir/lamivudine (24.99%), TAF/FTC (21.05%), dolutegravir (30.85%), efavirenz (29.02%), rilpivirine (9.36%), or elvitegravir/cobicistat (9.26%). Follow-up on these regimens ranged from 543.26 days on TAF/FTC to 779.99 days on abacavir/lamivudine.
Overall follow-up averaged 1.86 years, during which the study group gained an average 2.12% in relative weight and 1.64 kg (3.6 pounds). While 44.7% of participants changed their antiretroviral regimen at least once during the study period, only 1.7% changed twice.
Linear and logistic regression analyses adjusted for years in study, age, gender, and weight at study entry identified four nondrug factors independently associated with odds of a 5-kg or greater weight gain in the study period. Dieting trimmed chances of gaining at least 5 kg by 30% (adjusted odds ratio [aOR] 0.70, 95% confidence interval [CI] 0.50 to 0.97, P = 0.03). Male gender lowered odds about 40% (aOR 0.59, 95% CI 0.42 to 0.83, P = 0.003), and every 10 years of age cut odds about 25% (aOR 0.77, 95% CI 0.69 to 0.87, P < 0.001). Every additional year taking the same regimen raised odds of at least a 5-kg weight gain about 40% (aOR 1.39, 95% CI 1.20 to 1.61, P < 0.001).
This analysis independently tied 3 treatments to a greater chance of at least a 5-kg weight gain and 3 to a lower chance:
Greater chance of at least 5-kg weight gain
- TAF/FTC: aOR 2.06, 95% CI 1.48 to 2.87, P < 0.001
- Dolutegravir: aOR 1.36, 95% CI 1.02 to 1.80, P = 0.035
- Any integrase inhibitor: aOR 1.35, 95% CI 1.02 to 1.77, P = 0.03
Lower chance of at least 5-kg weight gain
- TDF/FTC: aOR 0.55, 95% CI 0.41 to 0.73, P < 0.001
- Darunavir/ritonavir: aOR 0.55, 95% CI 0.31 to 1.00, P = 0.05
- Efavirenz: aOR 0.65, 95% CI 0.47 to 0.91, P = 0.01
The researchers believe this is the first study to highlight the potential importance of diet in weight change among people taking current antiretroviral regimens. In an email to NATAP, presenting author Yesha Patel said the findings underline a "role of diet as a way to address weight gain via in-office counseling on lifestyle factors during scheduled office visits."
The study also makes it clear that weight gain in the current ART era can involve several factors, including demographics, behaviors, and type of antiretroviral regimen. The research reinforces previous work linking integrase inhibitors and TAF to weight gain.
Reference
1. Patel Y, Doshi A, Levesque A, et al. Improvement in diet attenuates antiretroviral therapy (ART) associated weight gain in persons with human immunodeficiency virus (PWH). IDWeek, September 29-October 3, 2021. Abstract 835.
Methods: This was a single-center, retrospective, cohort study of adult PWH on ART for at least 3 months seen at our clinic from 1/1/2015 to 1/1/2019. Patients with CD4+ T cell count < 200 cells/mm3, viral load > 200 copies/mL, history of malignancy, or pregnancy were excluded. 870 patients met criteria. Patient demographics, lifestyle factors, medical co-morbidities, concurrent medications, and ART regimens were documented during the study period. The primary outcome was percent weight change over the follow up period. Secondary outcome was the odds of > 5kg weight gain over the study period. The effects of concurrent medications, medical comorbidities, ART combinations, and self-reported lifestyle behaviors on these outcomes were modeled using mixed effect linear and logistic regression analysis.
Results:
At baseline, 83.6% were male, 29.2% were African American, and 65.6% had a body mass index ≥ 25 kg/m. Over a mean follow up of 1.86 years, the study population gained a mean percent weight of 2.12 ± 0.21% (p< 0.001) with an odds of weight gain >5kg of 0.293 (p< 0.001). Male sex and increasing age were significantly associated with a decrease in percent weight over the study period as reflected in the table below. Diet was also significantly associated with a decrease in percent weight change over the study period of -1.99 ± 0.47 %, p= < 0.001 and a lower odds of > 5kg of weight gain (OR= 0.70, 95% CI= 0.50 - 0.97, p=0.03). In regression models, combination therapy with tenofovir alafenamide (TAF) and integrase strand transfer inhibitor (INSTI) containing regimens were significantly associated with an increase in percent weight over the study period. Other significant factors including demographics and ART regimens are noted in Table 1. Multivariable Regression Models*
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