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  AIDS 2022
July 29 - Aug 2
24th Intl AIDS Conference
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Switching From Integrase Inhibitor to PI Trims Weight in HIV Patient Database
  AIDS 2022, July 29-August 2, Montreal
Mark Mascolini
Trading an integrase inhibitor (INSTI) for a protease inhibitor (PI)-but not for another INSTI-led to loss of weight gained during initial INSTI therapy in an insurance/prescription database study [1]. People who swapped one INSTI for another generally continued to gain weight.
Research verifies gains in weight or body mass index (BMI) in both antiretroviral-naive and experienced people starting their first INSTI. Because little work explores what happens to weight when people trade their first INSTI for another INSTI or for a PI, researchers at Janssen Scientific Affairs and the Analysis Group in Montreal conducted this retrospective, longitudinal cohort study.
Participants came from Symphony Health's IDV database, a provider-based electronic database with information including medications prescribed and administered, lab results, clinical diagnoses, and weight and BMI. The analysis focused on HIV-positive people prone to INSTI weight gains-women, black women or men, and Hispanic women or men. They all started a regimen including an integrase inhibitor (raltegravir, dolutegravir, elvitegravir, bictegravir) then switched to a PI (darunavir, atazanavir) or a different INSTI.
Among 17,312 people who started an INSTI, 334 (1.9%) later switched to a PI and 727 (4.2%) switched to another INSTI. After applying study entry and exclusion criteria, the researchers ended up with 46 people in the INSTI-to-PI group (called the PI cohort) and 310 in the INSTI-to-INSTI group (called the INSTI cohort). The researchers used inverse probability of treatment weights to balance baseline traits between the PI and INSTI groups. This process yielded weighted sample sizes of 153 people in the PI group and 203 in the INSTI group.
Age averaged 42.5 in the PI cohort and 45.5 in the INSTI cohort. Respective proportions of women were 60.3% and 52.4%, blacks 49.1% and 53.5%, Hispanics 15.6% and 14.5%, whites 6.2% and 8.8%, residence in the US South 76.8% and 76.0%, commercial insurance 65.1% and 62.0%, Medicaid 20.9% and 18.4%, and Medicare 8.7% and 9.4%.
Time taking the initial INSTI averaged 14.7 months in the PI cohort and 19.9 months in the INSTI cohort. Initial BMI averaged 29.5 in the PI cohort and 29.8 in the INSTI cohort, close to the obesity threshold. After starting their first INSTI, BMI rose 5% or more in 35.1% who later switched to a PI and in 18.9% who later switched to another INSTI. Weight gains of 5% or more on the first INSTI occurred in 35.1% who later switched to a PI and in 18.9% who switched to another INSTI.
In the PI cohort average weight rose from 80.8 kg before the initial INSTI to 84.6 kg while taking the initial INSTI then leveled off to 84.8 kg after the switch to a PI. In the INSTI cohort average weight started higher but rose more slowly from 84.1 kg before the initial INSTI to 85.0 kg while taking the initial INSTI, then kept climbing to 86.1 kg after the switch to the second INSTI. This same pattern held true when the researchers measured weight as BMI.
Nine and 12 months after switching from the initial INSTI, people who switched to a PI had an overall average drop in weight, while people who switched to another INSTI had an overall average gain in weight, and that difference widened over time. The proportion of people who had any or at least a 5% increase in weight or BMI was numerically higher (but not significantly higher) in the INSTI cohort than in the PI cohort at most points in time.
The Janssen/Analysis Group investigators believe this is the first study on weight change after switching from an INSTI "that supports the idea that ART management may be an option to mitigate or reverse INSTI-related weight gain" in people with a higher risk of such gains-women, blacks, and Hispanics.
1. Donga P, Emond B, Shah A, et al. Can ART switch mitigate or reverse INSTI-related weight or BMI gain in high risk people living with HIV-1? 2022, July 29-August 2, Montreal. Abstract EPB111.