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Final week 192 results from the ADVANCE trial: first-line TAF/FTC/DTG, TDF/FTC/DTG vs TDF/FTC/EFV - weight gain
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AIDS 2022 July 29-Aug 1 Montreal
Andrew Hill
Authors
W.D.F. Venter (1), B. Bosch (1), S. Sokhela (1), G. Akpomiemie (1), N. Chandiwana (1), A. Tembo (1), A. Qavi (2), B. Simmons (3), K. McCann (4), A. Hill * (5)
Institutions
(1) Ezintsha, University of the Witwatersrand, Johannesburg, South Africa, (2) Imperial College London, London, United Kingdom, (3) London School of Economics and Political Science, London, United Kingdom, (4) University of Connecticut, Connecticut, United States, (5) University Of Liverpool, Liverpool, United Kingdom
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What's going on?
At this conference ADVANCE & NAMSAL 192 week study results were reported, yesterday I emailed out to NATAP listserve NAMSAL slide presentation. These studies find increased weight associated with DTG and also separately below in this study for TAF. This is not new, but - Let's review the information around this that has already been out there in discussion. We don't know for sure why these weight gains are occurring & what is causing them. But there has been a lot of discussion around this over the past few years. TDF & EFV have been associated with keeping weight down. Switching to TAF from TDF has been associated with weight gain and it us thought because TDF was keeping weight down so switching to TAF just eliminating what was causing keeping weigh down, from increasing. It is thought that both EFV & TDF both might reduce appetite and that DTG might be better associated with a return to normal health & perhaps more normal appetite - don't underestimate the return to health explanation. As well the generic CYP2B6 genotype appears to be treated to EFV & DTG weight changes.
A study at CROI 2020 - webcast "Dolutegravir use is Associated with Higher Postpartum Weight Compared to EFV", found "women living with HIV on DTG have persistently higher weight through 18 months postpartum than those on EFV in Botswana but similar weight to HIV-uninfected women". In the abstract: In Africans starting EFV-based ART CYP2B6 metaboliser genotype was associated with weight gain and, in women, with changes in limb fat. The similar weight gain observed between CYP2B6 extensive metabolisers in the EFV/TDF/FTC arm and the DTG/TDF/FTC arm suggests off-target effects (e.g. mitochondrial toxicity) impairing weight gain in EFV slow/intermediate metabolisers could explain the greater weight gain observed with DTG in African trials.
Another study at CROI 2020, "CYP2B6 Genotype and Weight-gain differences Between DTG & EFV" - found this.....
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Final week 192 results from the ADVANCE trial: first-line TAF/FTC/DTG, TDF/FTC/DTG vs TDF/FTC/EFV
AIDS 2022 July 29-Aug 1 Montreal
Andrew Hill
Authors
W.D.F. Venter (1), B. Bosch (1), S. Sokhela (1), G. Akpomiemie (1), N. Chandiwana (1), A. Tembo (1), A. Qavi (2), B. Simmons (3), K. McCann (4), A. Hill * (5)
Institutions
(1) Ezintsha, University of the Witwatersrand, Johannesburg, South Africa, (2) Imperial College London, London, United Kingdom, (3) London School of Economics and Political Science, London, United Kingdom, (4) University of Connecticut, Connecticut, United States, (5) University Of Liverpool, Liverpool, United Kingdom
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