1
|
Taramasso L, Dettori S, Ricci E, Lerta S, Mora S, Blanchi S, Giacomini M, Vena A, Bassetti M, Di Biagio A. Weight Gain in Overweight and Obese People with HIV-The OBHIV Cohort. J Clin Med 2024; 13:1211. [PMID: 38592054 PMCID: PMC10932370 DOI: 10.3390/jcm13051211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND HIV and non-HIV-related factors have been related to weight gain (WG); however, their specific impact on people with HIV (PWH) who are overweight or obese remains unclear. METHODS This is a single-center observational study enrolling PWH with a BMI > 25 kg/m2. A generalized linear model was used to assess variables related to greater WG during 12 years of observation. RESULTS A total of 321 PWH were enrolled, 67% overweight and 33% obese, who gained an average of 0.2 ± 1.3 and 1.7 ± 1.5 kg/year, respectively (p < 0.0001). Years since HIV infection were the only variable significantly associated with WG (β -0.048, 95% CI -0.083; -0.013) during the study period, while type of ART did not influence the outcome. Narrowing the observation to the period of the SARS-CoV-2 pandemic, PWH with a longer duration of infection (β 0.075, 95% CI 0.033; 0.117) and a greater increase in triglycerides (β 0.005; 95% CI 0.000; 0.011) gained more weight, while higher BMI (β -0.256, 95% CI -0.352; -0.160), obesity (β -1.363, 95% CI -2.319; -0.408), diabetes mellitus (β -1.538, 95% CI -2.797; -0.278), and greater abdominal circumference (β -0.086, 95% CI -0.142; -0.030) resulted in protection. CONCLUSION Among overweight and obese PWH, the amount of WG was higher in the first years after diagnosis of HIV and decreased thereafter, despite aging, regardless of the type of ART.
Collapse
Affiliation(s)
- Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
| | - Silvia Dettori
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Elena Ricci
- Fondazione ASIA Onlus, Buccinasco, 20090 Milan, Italy;
| | - Sonia Lerta
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, 16126 Genoa, Italy; (S.M.); (M.G.)
| | - Sabrina Blanchi
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, 16126 Genoa, Italy; (S.M.); (M.G.)
| | - Antonio Vena
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Matteo Bassetti
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| |
Collapse
|
2
|
Bailin SS, Koethe JR, Rebeiro PF. The pathogenesis of obesity in people living with HIV. Curr Opin HIV AIDS 2024; 19:6-13. [PMID: 37934696 PMCID: PMC10842175 DOI: 10.1097/coh.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The public health challenge of overweight and obesity increasingly affects people living with HIV (PWH). These effects have also accelerated as the prevalence of antiretroviral therapy (ART) use has increased among PWH. It is therefore also critical that we examine and understand the pathogenesis of obesity among PWH.This review will aim to summarize relevant and recent literature related to the risks of weight gain and obesity associated with HIV disease progression, cardiometabolic disease, and multimorbidity among PWH. Further, we will discuss adipose tissue changes associated with weight gain and obesity and how these changes relate to metabolic complications. RECENT FINDINGS Several observational and experimental studies in recent years have evaluated the role of contemporary ART regimens, particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF), as contributors to weight gain, obesity, and cardiometabolic disease, though the mechanisms remain unclear. Metabolic dysregulation has also been linked to ectopic fat deposition and alterations in innate and adaptive immune cell populations in adipose tissue that accompany HIV and obesity. These factors continue to contribute to an increasing burden of metabolic diseases in an aging HIV population. SUMMARY Obesity accompanies an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
Collapse
Affiliation(s)
| | - John R Koethe
- Department of Medicine, Division of Infectious Diseases
| | - Peter F Rebeiro
- Department of Medicine, Division of Infectious Diseases
- Department of Medicine, Division of Epidemiology
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
3
|
Cheng PN, Feng IC, Chen JJ, Kuo HT, Lee PL, Yu ML, Chiu YC, Chiu HC, Chien SC, Chen PJ, Liu CJ. Body weight increase and metabolic derangements after tenofovir disoproxil fumarate switch to tenofovir alafenamide in patients with chronic hepatitis B. Aliment Pharmacol Ther 2024; 59:230-238. [PMID: 37845815 DOI: 10.1111/apt.17765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Lipid-lowering effect was observed during treatment with tenofovir disoproxil fumarate (TDF) for chronic hepatitis B (CHB). However, the metabolic features in patients switching from TDF to tenofovir alafenamide (TAF) remain unclear. AIMS To compare the impacts of switching from TDF to TAF or from entecavir to TAF on body weight and metabolic features in patients with CHB. METHODS This was a multi-centre, prospective, observational study in patients with CHB on TDF or entecavir who switched to TAF. Baseline characteristics, lipid profile and sugar profile were determined. This study received IRB approval from each hospital. RESULTS We enrolled 177 patients on TDF (99) or entecavir (78) and followed them for 48 weeks after the switch to TAF. At baseline, TDF-experienced patients had lower serum triglyceride, total cholesterol, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol than entecavir-experienced patients. The switch from TDF to TAF significantly increased body weight, triglyceride, total cholesterol, HDL, LDL, fasting glucose, glycaemic haemoglobin, insulin and insulin resistance. The switch from entecavir to TAF did not affect these measures. There was no significant difference in atherosclerotic cardiovascular disease risk scores between groups. CONCLUSIONS The switch from TDF to TAF was associated with weight gain, derangements of lipid profile, and increased insulin resistance in patients with CHB. Long-term effects on these metabolic features need further investigation.
Collapse
Affiliation(s)
- Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Cher Feng
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Pei-Lun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, College of Medicine, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yen-Cheng Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chih Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chieh Chien
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
4
|
Wohlfeiler MB, Weber RP, Brunet L, Siddiqui J, Harbour M, Phillips AL, Hayward B, Fusco JS, Hsu RK, Fusco GP. Definition, Burden, and Predictors of HIV-Associated Wasting and Low Weight in the OPERA Cohort. AIDS Res Hum Retroviruses 2023; 39:636-643. [PMID: 37489298 PMCID: PMC10712360 DOI: 10.1089/aid.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
We aimed to describe the prevalence, incidence, and predictors of HIV-associated wasting (HIVAW)/low weight among people with HIV (PWH) in the United States. We conducted an observational, clinical cohort analysis, utilizing prospectively collected electronic health record data obtained from the Observational Pharmaco-Epidemiology Research & Analysis (OPERA®) cohort. HIVAW/low weight included a wasting or low body-mass index (BMI)/underweight diagnosis (ICD codes and title search) or BMI <20 kg/m2. Prevalence was estimated among adult PWH in care from 2012 to 2015 and 2016 to 2020. Incidence from January 1, 2016, to October 31, 2021, was estimated using univariate Poisson regression among eligible PWH without prior HIVAW/low weight. Demographic and clinical predictors of incident HIVAW/low weight were included in multivariable logistic regression models, stratified by antiretroviral therapy (ART) experience. The period prevalence of HIVAW/low weight was 12% in both 2012-2015 and 2016-2020. Among 67,119 PWH without any prior HIVAW/low weight, 7% experienced incident HIVAW/low weight a median 64 months from HIV diagnosis. In multivariable regression models, similar predictor patterns were observed among ART-naïve and ART-experienced PWH without any prior HIVAW/low weight: lower odds of HIVAW/low weight with older age, female sex, Black race, and Hispanic ethnicity and higher odds with Medicaid. Notably, there was a dose-response relationship between increasing Veterans Aging Cohort Study Mortality Index scores and incident HIVAW/low weight in both groups. Wasting/low weight remains a challenge for PWH and may be underappreciated by providers. Advanced HIV and comorbidities significantly predict incident HIVAW/low weight. Increasing awareness of HIVAW, especially among frailer PWH, could improve the care of affected PWH.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Ricky K. Hsu
- AIDS Healthcare Foundation, New York, New York, USA
- NYU Langone Medical Center, New York, New York, USA
| | | |
Collapse
|
5
|
Patel YS, Doshi AD, Levesque AE, Lindor S, Moranville RD, Okere SC, Robinson DB, Taylor L, Lustberg ME, Malvestutto CD. Weight Gain in People with HIV: The Role of Demographics, Antiretroviral Therapy, and Lifestyle Factors on Weight. AIDS Res Hum Retroviruses 2023; 39:652-661. [PMID: 37276145 DOI: 10.1089/aid.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
We explored factors associated with weight gain among people with HIV (PWH) on antiretroviral therapy (ART) at The Ohio State University Wexner Medical Center (OSUWMC). This was a retrospective cohort study of adult PWH on ART for ≥3 months. Patients with CD4+ T cell count <200 cells/mm3, viral load >200 copies/mL, history of malignancy, or pregnancy were excluded. Eight hundred seventy patients met criteria. The primary outcome was percent weight change over the follow-up period (Δ = relative effects). The secondary outcome was the odds of ≥5 kg weight gain over the study period. The effects of concurrent medications, medical comorbidities, ART combinations, and lifestyle behaviors on these outcomes were modeled using mixed effects regression analyses. Over a mean follow-up of 1.86 years, the study population gained a mean percent weight of 2.12% ± 0.21% (p < .001) with the odds of ≥5 kg weight gain of 0.293 (p < .001). Males gained an average of 1.88% ± 0.22% over follow up, while females gained an average of 3.37% ± 0.51% over follow up (p = .008 for the difference). In regression models, combination therapy with tenofovir alafenamide (TAF) and integrase strand transfer inhibitor (INSTI) containing regimens was associated with an increase in weight over the study period (Δ = 2.14% ± 0.45%, p < .001 and Δ = 1.09% ± 0.39%, p = .005, respectively). Increasing age was significantly associated with a decrease in percent weight change over the study period (Δ = -0.68% ± 0.18% per year, p < .001). Self-reported improvement in diet was associated with a decrease in weight change (Δ = -1.99% ± 0.47%, p ≤ .001) and reduced odds of ≥5 kg weight gain (odds ratio = 0.70, 95% confidence interval = 0.50-0.97, p = .03). Factors associated with weight gain include therapy with TAF and INSTI. Diet may play an influential role in attenuating weight gain in PWH.
Collapse
Affiliation(s)
- Yesha S Patel
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anjali D Doshi
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anna E Levesque
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Shelsie Lindor
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Sheila C Okere
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Lauren Taylor
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark E Lustberg
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
6
|
Pérez-Barragán E, Guevara-Maldonado MF, Mancilla-Galindo J, Kammar-García A, Ortiz-Hernández A, Mata-Marín JA, Pérez-Cavazos S. Weight Gain After 12 Months of Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed HIV Patients. AIDS Res Hum Retroviruses 2023; 39:511-517. [PMID: 37071218 DOI: 10.1089/aid.2022.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Recent studies suggest that the introduction of antiretroviral agents such as integrase strand transfer inhibitors (INSTI) may lead to weight gain in people living with HIV (PLHIV). In this retrospective observational study, we report the weight changes observed in virologically suppressed HIV patients after 12 months of switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) due to a national change in public policy in Mexico. Patients on prior regimens based on TDF/FTC or ABC/3TC plus non-nucleoside retrotranscriptase inhibitor, INSTI, or protease inhibitor were included. In the 399 patients analyzed, a significant weight increase was found, as well as an increase in body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, creatinine, and CD4+ cells after 12 months of switching treatment (all p ≤ .001). Mean weight gain was 1.63 kg [confidence interval (95% CI): 1.14-2.11], whereas the average percentage of weight gained was 2.5% (95% CI: 1.83-3.17). After considering the confounding effect of baseline weight status, the change in weight and BMI did not present significant differences between any of the prior treatment schemes. In conclusion, PLHIV switching to BIC/F/TAF therapy experienced weight gain after the first year of switching treatment. Although this weight gain could be due to the switch in treatment regimen, it cannot be excluded that it was caused by other factors since no comparable control group could be used for comparison.
Collapse
Affiliation(s)
- Edgar Pérez-Barragán
- Servicio de Infectología, Hospital General de Zona N° 48, Ciudad de México, México
| | | | - Javier Mancilla-Galindo
- División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Ciudad de México, México
| | | | - José Antonio Mata-Marín
- Servicio de Infectología, Hospital de Infectología, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Samantha Pérez-Cavazos
- Departamento de Epidemiología Hospitalaria/Servicio de Infectología, Hospital Christus Muguerza Betania, Puebla, México
| |
Collapse
|
7
|
Ken-Opurum J, Prajapati G, Matos JE, Goswami S, Kumar P. Body mass index and quality of life in people living with HIV. AIDS Care 2023; 35:1542-1554. [PMID: 36912678 DOI: 10.1080/09540121.2023.2185195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
With advances in the treatment of HIV, people living with HIV (PLWH) are now expected to have a near-normal life expectancy, but challenges remain in the form of substantially poorer health-related quality of life (HRQoL) than the general population. Being overweight or obese may pose an additional burden in PLWH, but few studies have evaluated the relationship between body mass index (BMI) and HRQoL in PLWH. This study aimed to evaluate and describe the association between HRQoL and BMI among PLWH in the US. Data were obtained from the 2018 and 2019 US National Health and Wellness Survey, an online, self-reported, general population survey. Analyses included 575 PLWH who self-reported a physician diagnosis and prescription use for the treatment of HIV, as well as 1725 propensity score matched non-HIV controls. After adjusting for age, sex, race, and comorbidities, higher BMI was associated with poorer physical (β = -0.18, p = 0.005) and general (β = -0.42, p = 0.014) HRQoL among PLWH. Additionally, PLWH reported poorer mental, physical, and general HRQoL than non-HIV controls; these relationships were not moderated by BMI. The potential negative impact of higher BMI on patients' humanistic outcomes should be considered in HIV management, including selection of treatment.
Collapse
Affiliation(s)
| | | | | | | | - Princy Kumar
- Georgetown University Medical Center, Washington DC, USA
| |
Collapse
|
8
|
Hocqueloux L, Menard A, Arvieux C, Joly V, Becker A, Chéret A, Duvivier C, Cabié A, Delpierre C, Allavena C. Weight gain following the single substitution of tenofovir disoproxil fumarate by tenofovir alafenamide in HIV-infected people from the French Dat'AIDS cohort: A propensity score-matched analysis. HIV Med 2023; 24:925-932. [PMID: 37015896 DOI: 10.1111/hiv.13488] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/13/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To minimize confounding factors, we aimed to describe the changes in weight and body mass index (BMI) following the single substitution of tenofovir disoproxil fumarate (TDF) by tenofovir alafenamide (TAF) in people living with HIV (PLWH). METHODS We designed a retrospective study in a large French cohort. We included all HIV-suppressed adults under TDF + emtricitabine + rilpivirine or elvitegravir/cobistat, who experienced a first switch from TDF to TAF, while other antiretrovirals remained unchanged (Switch group). We compared this population to a propensity score-matched Control group (1:1) who stayed on the same TDF-based regimen. Changes were evaluated after 6 (M6) and 12 months (M12). RESULTS Some 1260 and 468 PLWH were evaluable per group at M6 and M12, respectively. In the Switch group, there was a mean (95% confidence interval [95% CI]) weight gain of +1014 g (+826 to +1201) at M6 (p < 0.0001) and +1365 g (+910 to +1820) at M12 (p < 0.0001), as compared with baseline. Meanwhile, there was no significant weight gain at M6 (+139 g [-50 to +328]) and M12 (-32 g [-413 to +350]) in the matched Control group. Similarly, mean BMI increased significantly in the Switch group at M6 (+0.35, 95% CI: +0.29 to +0.41, p < 0.0001) and M12 (+0.49, 95% CI: +0.32 to +0.65, p < 0.0001), while it was stable at M6 (+0.05, 95% CI: -0.01 to +0.12, p = 0.11) and M12 (+0.01, 95% CI: -0.12 to +0.14, p = 0.89) in the No Switch group. CONCLUSIONS Although modest, there is a significant weight gain following the substitution of TDF by TAF. This should be anticipated in certain at-risk populations.
Collapse
Affiliation(s)
| | | | | | - Véronique Joly
- Bichat-Claude Bernard University Hospital, Paris, France
| | - Agathe Becker
- Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Claudine Duvivier
- APHP, Necker-Pasteur Infectiology Center, University Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, IHU Imagine, Paris, France
| | - André Cabié
- Martinique University Hospital, Fort-de-France, France
| | | | | |
Collapse
|
9
|
Nasreddine R, Florence E, Yombi JC, Henrard S, Darcis G, Van Praet J, Vandekerckhove L, Allard SD, Demeester R, Messiaen P, Ausselet N, Delforge M, De Wit S. Efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide for the treatment of HIV in a real-world setting in Belgium. HIV Med 2023; 24:914-924. [PMID: 37038245 DOI: 10.1111/hiv.13493] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Our objective was to evaluate the efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in a real-world setting in Belgium. METHODS This was a retrospective, multicentre cohort study involving adult treatment-naïve (TN) and treatment-experienced (TE) people living with HIV receiving BIC/FTC/TAF between 1 January 2019 and 30 September 2020. The primary outcome was rate of virological suppression (plasma HIV-1 viral load <50 copies/mL; on-treatment analysis) at weeks 24 and 48. The main secondary outcomes included loss of virological suppression (LVS; two consecutive viral loads of >200 copies/mL after being virologically suppressed) by week 48 and analysis of resistance-associated mutations at time of LVS; tolerability of BIC/FTC/TAF over the 48-week study period; and change in weight and proportion of participants reporting a >10% weight gain at week 48. RESULTS Overall, 2001 participants were included. Through 48 weeks, overall rate of virological suppression was 93.5%, with similar results observed in the following subgroups: age ≥50 years (92.7%), women (92.8%), Black sub-Saharan African (91%), TN (94%), TE (93.2%), and non-suppressed at baseline (86.6%). LVS was observed in 0.7% (n = 14) of participants, with one participant developing resistance-associated mutations to nucleoside reverse transcriptase inhibitors (184 V) and integrase strand transfer inhibitors (263KR). Of the 131 (6.5%) treatment discontinuations, the most common reason was an adverse event (2.4%), with the most frequent being central nervous system/psychiatric (0.4%) and gastrointestinal (0.4%) toxicity. Median weight gain at week 48 was 2 kg (interquartile range -1 to 5), and a >10% weight increase was observed in 11.6% of participants. CONCLUSION In this large real-world cohort, BIC/FTC/TAF showed excellent virological efficacy in a diverse population of patients with HIV. Rare occurrence of emergent drug resistance was observed, and treatment was well tolerated.
Collapse
Affiliation(s)
| | | | | | - Sophie Henrard
- University Clinics of Brussels - Erasme Hospital, Brussels, Belgium
| | | | | | | | | | - Rémy Demeester
- University Hospital of Charleroi, Lodelinsart, Charleroi, Belgium
| | | | | | | | | |
Collapse
|
10
|
Donga P, Emond B, Rossi C, Bookhart BK, Lee J, Caron-Lapointe G, Wei F, Lafeuille MH. Weight and BMI Changes Following Initiation of Emtricitabine/Tenofovir Alafenamide Co-Formulated with Darunavir or Co-Administered with Dolutegravir in Overweight or Obese, ART-Naïve People Living with HIV-1. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:579-591. [PMID: 37521004 PMCID: PMC10377594 DOI: 10.2147/ceor.s413800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Integrase strand transfer inhibitor-based regimens (eg, containing dolutegravir [DTG]) are associated with weight/body mass index (BMI) increases among people living with HIV-1 (PLWH). Assessing antiretroviral therapy (ART)-related weight/BMI changes is challenging, as PLWH may experience return-to-health weight gain as a result of viral suppression. This retrospective, longitudinal real-world study compared weight/BMI outcomes among overweight/obese (BMI ≥25 kg/m2; thus excluding return-to-health weight/BMI changes), treatment-naïve PLWH who initiated darunavir (DRV)/cobicistat (c)/emtricitabine (FTC)/tenofovir alafenamide (TAF) or DTG + FTC/TAF. Methods Treatment-naïve PLWH with BMI ≥25 kg/m2 who initiated DRV/c/FTC/TAF or DTG + FTC/TAF (index date) had ≥12 months of baseline observation and ≥1 weight/BMI measurement in baseline and post-index periods in the Symphony Health IDV® database (07/17/2017-12/31/2021) were included. Inverse probability of treatment weighting (IPTW) was used to balance differences in baseline characteristics between cohorts. On-treatment time-to-weight/BMI increases ≥5% were compared between cohorts using weighted adjusted Cox models. Results Post-IPTW, 76 overweight/obese DRV/c/FTC/TAF-treated (mean age = 51.2 years, 30.7% female, 35.6% Black, mean baseline BMI = 33.2 kg/m2) and 88 overweight/obese DTG + FTC/TAF-treated PLWH (mean age = 51.5 years, 31.4% female, 31.4% Black, mean baseline BMI = 32.7 kg/m2) were included. The median [interquartile range] time from ART initiation to weight/BMI increase ≥5% was shorter for the DTG + FTC/TAF cohort (21.8 [9.9, 32.3] months) than the DRV/c/FTC/TAF cohort (median and interquartile times not reached; Kaplan-Meier rate at 21.8 months = 20.8%). Over the entire follow-up, overweight/obese PLWH initiating DTG + FTC/TAF had a more than twofold greater risk of experiencing weight/BMI increase ≥5% compared to those initiating DRV/c/FTC/TAF (hazard ratio [95% confidence interval]=2.43 [1.02; 7.04]; p = 0.036). Conclusion Overweight/obese PLWH who initiated DTG + FTC/TAF had significantly greater risk of weight/BMI increase ≥5% compared to similar PLWH who initiated DRV/c/FTC/TAF and had shorter time-to-weight/BMI increase ≥5%, suggesting a need for additional monitoring to assess the risk of weight gain-related cardiometabolic disease.
Collapse
Affiliation(s)
- Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | | | - Johnnie Lee
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | | |
Collapse
|
11
|
Guaraldi G, Bonfanti P, Di Biagio A, Gori A, Milić J, Saltini P, Segala FV, Squillace N, Taramasso L, Cingolani A. Evidence gaps on weight gain in people living with HIV: a scoping review to define a research agenda. BMC Infect Dis 2023; 23:230. [PMID: 37060030 PMCID: PMC10103467 DOI: 10.1186/s12879-023-08174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/17/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Combined antiretroviral therapy (cART) dramatically improved survival in people living with HIV (PLWH) but is associated with weight gain (WG), raising concern for a possible obesity epidemic in PLWH. This scoping review aims to identify the gaps in the existing evidence on WG in PLWH and generate a future research agenda. METHODS This review was conducted according to the methodology for scoping studies and reported according to the PRISMA Extension for Scoping Review checklist. Articles published in English in the last 10 years indexed in Pubmed, WHO Global Index Medicus, or Embase were searched using specific queries focused on WG in PLWH. RESULTS Following the selection process, 175 included articles were reviewed to search for the available evidence on four specific topics: (I) definition of WG in PLWH, (II) pathogenesis of WG in PLWH, (III) impact of ART on WG, (IV) correlation of WG with clinical outcomes. A summary of the data enabled us to identify gaps and clearly define the following research agenda: (I) develop a data-driven definition of WG in PLWH and define noninvasive assessment methods for body weight and fat composition; (II) further investigate the interaction between HIV/cART and immunity, metabolism, and adipose tissue; (III) establish the specific role of individual drugs on WG; (IV) clarify the independent role of WG, cART, HIV, and metabolic factors on clinical events. CONCLUSIONS The proposed research agenda may help define future research and fill the knowledge gaps that have emerged from this review.
Collapse
Affiliation(s)
- Giovanni Guaraldi
- HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Jovana Milić
- HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Saltini
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco V Segala
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Antonella Cingolani
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
| |
Collapse
|
12
|
Weight Gain and Metabolic Effects in Persons With HIV Who Switch to ART Regimens Containing Integrase Inhibitors or Tenofovir Alafenamide. J Acquir Immune Defic Syndr 2023; 92:67-75. [PMID: 36150045 DOI: 10.1097/qai.0000000000003101] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The timing and magnitude of antiretroviral therapy-associated weight change attributions are unclear. SETTING HIV Outpatient Study participants. METHODS We analyzed 2007-2018 records of virally suppressed (VS) persons without integrase inhibitor (INSTI) experience who switched to either INSTI-based or another non-INSTI-based ART, and remained VS. We analyzed BMI changes using linear mixed models, INSTI- and tenofovir alafenamide (TAF) contributions to BMI change by linear mixed models-estimated slopes, and BMI inflection points. RESULTS Among 736 participants (5316 person-years), 441 (60%) switched to INSTI-based ART; the remainder to non-INSTI-based ART. The mean follow-up was 7.15 years for INSTI recipients and 7.35 years for non-INSTI. Preswitch, INSTI and non-INSTI groups had similar median BMI (26.3 versus 25.9 kg/m 2 , P = 0.41). INSTI regimens included raltegravir (178), elvitegravir (112), and dolutegravir (143). Monthly BMI increases postswitch were greater with INSTI than non-INSTI (0.0525 versus 0.006, P < 0.001). A BMI inflection point occurred 8 months after switch among INSTI users; slopes were similar regardless of TAF use immediately postswitch. Among INSTI + TAF users, during 8 months postswitch, 87% of BMI slope change was associated with INSTI use, 13% with TAF use; after 8 months, estimated contributions were 27% and 73%, respectively. For non-INSTI+TAF, 84% of BMI gain was TAF-associated consistently postswitch. Persons switching from TDF to TAF had greater BMI increases than others ( P < 0.001). CONCLUSION Among VS persons who switched ART, INSTI and TAF use were independently associated with BMI increases. During 8 months postswitch, BMI changes were greatest and most associated with INSTI use; afterward, gradual BMI gain was largely TAF-associated.
Collapse
|
13
|
Hsu RK, Brunet L, Fusco JS, Mounzer K, Lamori JC, Fusco GP. Excessive Weight Gain: Current Antiretroviral Agents in Virologically Suppressed People with HIV. AIDS Res Hum Retroviruses 2022; 38:782-791. [PMID: 35923143 DOI: 10.1089/aid.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
An observational cohort study was conducted with data from the Observational Pharmaco-Epidemiology Research & Analysis (OPERA) cohort to investigate weight gain among virologically suppressed people with HIV (PWH) switching to regimens containing tenofovir alafenamide/emtricitabine/(TAF/FTC). Virologically suppressed, antiretroviral therapy (ART)-experienced PWH switching to TAF/FTC with darunavir/cobicistat (DRV/c), elvitegravir/cobicistat (EVG/c), dolutegravir (DTG), or bictegravir (BIC) were selected. Cox proportional hazards models were used to assess the risk of excessive weight gain (i.e., ≥5% gain within 28 weeks or ≥10% within 54 weeks), by regimen. A linear mixed effects model with random intercept and restricted cubic splines on time was used to assess continuous changes in weight. Confounding was controlled for with both inverse probability of treatment weighting and traditional covariate adjustment. Among 5,536 PWH, 18% gained ≥5% of their weight within 28 weeks, and 9% gained ≥10% within 54 weeks. There were no differences in the risk of excessive weight gain by regimen, although there was a nonstatistically significant 20% increase in the risk of gaining ≥10% within 54 weeks with all regimens compared to DRV/c. Throughout follow-up, the mean predicted weight remained fairly constant, with no notable differentiation between regimens. Expected weight gains ranged from +0.2 to +0.3 kg at 6 months and from +0.5 to +0.6 kg at 24 months. In conclusion, in this study of virologically suppressed, ART-experienced PWH switching to regimens containing TAF/FTC and DRV/c, EVG/c, DTG, or BIC, up to 18% experienced excessive levels of weight gain. However, no statistically significant difference was observed across regimens.
Collapse
Affiliation(s)
- Ricky K Hsu
- AIDS Healthcare Foundation, New York, New York, USA.,NYU Langone Medical Center, New York, New York, USA
| | | | | | | | - Joyce C Lamori
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | | |
Collapse
|
14
|
Verburgh ML, Wit FW, Boyd A, Verboeket SO, Reiss P, van der Valk M. One in ten virally suppressed persons with HIV in the Netherlands experiences ≥10% weight gain after switching to TAF and/or INSTI. Open Forum Infect Dis 2022; 9:ofac291. [PMID: 35873291 PMCID: PMC9301581 DOI: 10.1093/ofid/ofac291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
We determined the frequency of and factors associated with ≥10% weight gain and its metabolic effects in virally suppressed people with HIV (PWH) from the Dutch national ATHENA cohort switching to TAF and/or INSTI.
Methods
We identified ART-experienced, but TAF/INSTI-naïve PWH, who switched to a TAF and/or INSTI-containing regimen whilst virally suppressed for >12 months. Individuals with comorbidities/co-medication associated with weight change were excluded. Analyses were stratified by switch to only TAF, only INSTI or combined TAF + INSTI. Factors associated with ≥10% weight gain were assessed using parametric survival models. Changes in glucose, lipids and blood pressure post-switch were modelled using mixed-effect linear regression and compared between those with and without ≥10% weight gain.
Results
Among 1,544 PWH who switched to only TAF, 2,629 to only INSTI and 918 to combined TAF + INSTI, ≥10% weight gain was observed in 8.8%, 10.6% and 14.4%, respectively. Across these groups, weight gain was more frequent in Western and Sub-Saharan African females than Western males. Weight gain was also more frequent in those with weight loss ≥1 kg/yr before switching, age < 40 years, and those discontinuing efavirenz. In those with ≥10% weight gain, 53.7% remained in the same BMI category, whilst a BMI change from normal/overweight at baseline to obesity at 24 months post-switch was seen in 13.9%, 11.7% and 15.2% of those switching to only TAF, only INSTI and combined TAF + INSTI respectively. PWH with ≥10% weight gain showed significantly larger, but small increases in glucose, blood pressure and lipid levels. Lipid increases were limited to those whose switch included TAF, whereas lipids decreased after switching to only INSTI.
Conclusions
Weight gain of ≥10% after switch to TAF and/or INSTI was common in virally suppressed PWH, particularly in females and those starting both drugs simultaneously. Consequent changes in metabolic parameters were however modest.
Collapse
Affiliation(s)
- Myrthe L. Verburgh
- Amsterdam UMC location University of Amsterdam , Infectious Diseases, Meibergdreef 9, Amsterdam , The Netherlands
- Amsterdam Institute for Global Health and Development , Paasheuvelweg 25, Amsterdam , The Netherlands
| | - Ferdinand W.N.M. Wit
- Amsterdam UMC location University of Amsterdam , Infectious Diseases, Meibergdreef 9, Amsterdam , The Netherlands
- HIV Monitoring Foundation , Amsterdam , The Netherlands
| | - Anders Boyd
- HIV Monitoring Foundation , Amsterdam , The Netherlands
- Department of Infectious Diseases , Public Health Service of Amsterdam, Amsterdam , The Netherlands
| | - Sebastiaan O. Verboeket
- Amsterdam UMC location University of Amsterdam , Infectious Diseases, Meibergdreef 9, Amsterdam , The Netherlands
- Amsterdam Institute for Global Health and Development , Paasheuvelweg 25, Amsterdam , The Netherlands
| | - Peter Reiss
- Amsterdam UMC location University of Amsterdam , Infectious Diseases, Meibergdreef 9, Amsterdam , The Netherlands
- Amsterdam Institute for Global Health and Development , Paasheuvelweg 25, Amsterdam , The Netherlands
- Amsterdam UMC location University of Amsterdam , Global Health, Meibergdreef 9, Amsterdam , The Netherlands
| | - Marc van der Valk
- Amsterdam UMC location University of Amsterdam , Infectious Diseases, Meibergdreef 9, Amsterdam , The Netherlands
- HIV Monitoring Foundation , Amsterdam , The Netherlands
| |
Collapse
|
15
|
Taramasso L, Lo Caputo S, Magnasco L, Briano F, Poliseno M, Bruno SR, Ferrara S, Pincino R, Sarteschi G, Beltramini S, Sasso E, Mora S, Giacomini M, Bassetti M, Di Biagio A. Long-Term Effectiveness of Rilpivirine-Based Single-Tablet Regimens in a Seven-Year, Two-Center Observational Cohort of People Living with HIV. AIDS Res Hum Retroviruses 2022; 38:472-479. [PMID: 35172617 DOI: 10.1089/aid.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Data on the long-term durability of rilpivirine (RPV) are still scarce. A two-center retrospective study was performed, including all people living with HIV (PLWH) treated with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)/RPV or tenofovir alafenamide (TAF)/FTC/RPV in the period January 2013-December 2019. Aims of the study were to assess the rate of discontinuation of the RPV single-tablet regimen (STR) and identify factors associated with the risk of discontinuation according to Cox's regression analysis. A total of 684 PLWH were enrolled. Mean duration of RPV-STR treatment was 192.5 (±99.5) weeks for 123 antiretroviral therapy (ART)-naïve participants (18%) and 173.3 (± 85.6) weeks for 561 ART-experienced study participants (82%). During the study period, the incidence of discontinuation was 7.7 per 100 person-years. The estimated proportions of discontinuation after 48 and 96 weeks were 5.6% and 13.4%, respectively. Causes of discontinuation were loss to follow-up (30%), side effects (15%), ART optimization (14%), virological failure (VF) (12%), death or transfer to another center (9%), low adherence (7%), drug interactions (6%), simplification to dual therapy (3%), and unknown (3%). No differences were observed in cumulative probability of discontinuation between ART-naïve and -experienced PLWH. Heterosexual (hazard ratio [HR] 3.0, 95% confidence interval [CI] 1.4-6.8) and mother-to-child (HR 5.3, 95% CI 1.8-15.3) transmission of HIV infection and history of previous VF (HR 1.7, 95% CI 1.2-2.5) were associated with higher risk of discontinuation. High RPV-STR effectiveness and durability were confirmed in our real-life population of PLWH. Given these data, RPV has the potential to be a drug for life in patients selected according to current guidelines.
Collapse
Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Clinic, Department of Internal Medicine, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Sergio Lo Caputo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Laura Magnasco
- Infectious Diseases Clinic, Department of Internal Medicine, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Federica Briano
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Mariacristina Poliseno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Serena Rita Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Sergio Ferrara
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rachele Pincino
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giovanni Sarteschi
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | | | - Elisabetta Sasso
- Pharmacy Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| |
Collapse
|
16
|
Schafer JJ, Zimmerman M, Walshe C, Cerankowski J, Shimada A, Keith SW. Weight changes in patients with sustained viral suppression switching tenofovir disoproxil fumarate to tenofovir alafenamide. Obesity (Silver Spring) 2022; 30:1197-1204. [PMID: 35674696 DOI: 10.1002/oby.23443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Switching from tenofovir disoproxil fumarate (TDF)- to tenofovir alafenamide (TAF)-containing antiretroviral therapy may negatively influence weight, cholesterol, and atherosclerotic cardiovascular disease risk. The extent of these changes and their association with TAF remain unclear. METHODS This retrospective cohort evaluated metabolic changes in virologically suppressed patients with HIV infection who switched from TDF to TAF without switching other antiretroviral therapy medications. Adult patients on TDF and with no HIV viral load values >200 copies/mL for ≥2 years prior to and following a TAF switch were included. Weight and other variables were collected for 2 years before and after the switch. Longitudinal linear mixed-effects models evaluated changes at 1 and 2 years after the switch. RESULTS In the unadjusted analysis, there were increases in weight, BMI, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, fasting glucose, and atherosclerotic cardiovascular disease risk scores 2 years after switching to TAF (each p ≤ 0.03). However, only increases in total and low-density lipoprotein cholesterol were associated with TAF and were significantly different from expected changes predicted in the adjusted longitudinal models. CONCLUSIONS Despite observing significant unadjusted metabolic changes after switching to TAF, only changes in cholesterol were associated with TAF and were different from changes expected in time-trend adjusted models.
Collapse
Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matty Zimmerman
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ciara Walshe
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jesse Cerankowski
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ayako Shimada
- Sidney Kimmel Medical College, Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott W Keith
- Sidney Kimmel Medical College, Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
Emond B, Rossi C, Rogers R, Lefebvre P, Lafeuille MH, Donga P. Real-World Analysis of Weight Gain and Body Mass Index Increase Among Patients with HIV-1 Using Antiretroviral Regimen Containing Tenofovir Alafenamide, Tenofovir Disoproxil Fumarate, or Neither in the United States. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:39-49. [PMID: 35233432 PMCID: PMC8843358 DOI: 10.36469/jheor.2022.31825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Background: While some studies among patients with HIV-1 suggest that antiretroviral therapy (ART) regimens containing tenofovir alafenamide (TAF) may be associated with greater weight gain than those not containing TAF, no studies have assessed the relationship between TAF doses and weight change. Objectives: To evaluate weight-related outcomes among patients with HIV-1 in the United States initiating ART containing different nucleoside reverse transcriptase inhibitors and doses. Methods: A retrospective longitudinal study was conducted using Decision Resources Group's electronic medical records (July 17, 2017-March 1, 2020). Adult patients with HIV-1 initiating ART (index date) containing TAF 25 mg, TAF 10 mg, tenofovir disoproxil fumarate (TDF), or neither TAF nor TDF on or after July 17, 2018, were included. Changes in weight and body mass index (BMI) from pre-index to 3, 6, 9, and 12 months post-index were compared between cohorts using mean differences obtained from ordinary least squares models adjusted for baseline characteristics. Time-to-weight and BMI increase ≥5% were compared using Cox models adjusted for baseline characteristics. Results: Among 1652 eligible patients (TAF 25 mg, n=710; TAF 10 mg, n=303; TDF, n=219; non-TAF/TDF, n=420), the majority (83.2%-99.5%) initiated an integrase strand transfer inhibitor, except for the TDF cohort (45.2%). Patients initiating TAF 25 mg had greater weight or BMI increase across all time points compared with patients initiating TAF 10 mg, TDF, or non-TAF/TDF regimens (mean differences in weight or BMI changes between cohorts at 12 months post-index ranged from 0.78 kg [1.72 lb] to 1.34 kg [2.95 lb] and from 0.77 kg/m2 to 1.95 kg/m2, respectively), although findings were not statistically significant for all comparisons. Compared with TAF 25 mg, time-to-weight and BMI increase ≥5% in the other treatment cohorts were longer (hazard ratios ranged from 0.77 to 0.94), although findings were generally not statistically significant. Conclusions: Among a population of patients predominantly initiating integrase strand transfer inhibitors, increases in weight and BMI post-ART initiation were common and appeared to be higher and occur more rapidly among patients receiving TAF 25 mg compared with lower TAF doses or other nucleosides. When considering long-term health consequences, weight gain is an important factor to consider when selecting an ART regimen.
Collapse
Affiliation(s)
- Bruno Emond
- Analysis Group, Inc., Montréal, Québec, Canada
| | | | - Rachel Rogers
- Janssen Scientific Affairs, LLC., Titusville, New Jersey, USA
| | | | | | - Prina Donga
- Janssen Scientific Affairs, LLC., Titusville, New Jersey, USA
| |
Collapse
|
18
|
Mallon PWG, Brunet L, Fusco JS, Prajapati G, Beyer A, Fusco GP, Wohlfeiler MB. Lipid Changes After Switch From TDF to TAF in the OPERA Cohort: LDL Cholesterol and Triglycerides. Open Forum Infect Dis 2022; 9:ofab621. [PMID: 35028335 PMCID: PMC8753026 DOI: 10.1093/ofid/ofab621] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022] Open
Abstract
Background Increases in lipids have been observed in people with HIV (PWH) switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF). We assessed changes in low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) following a switch from TDF to TAF. Methods Adults with ≥1 lipid measure before and after switch from TDF to TAF were identified in the OPERA cohort. Multivariable linear regression using generalized estimating equations was used to estimate predicted changes in lipids over time on TAF, modeled flexibly with linear splines. Results A total of 6451 PWH switched from TDF to TAF, of whom 4328 maintained all other agents. LDL-C increased significantly by 1.40 mg/dL/mo over the first 3 months on TAF, by 0.33 mg/dL/mo between 3 and 9 months and then plateauing beyond 9 months. TG increased significantly by 3.52 mg/dL/mo over the first 3 months of TAF, by 0.91 mg/mL/mo between 3 and 9 months and by 0.72 mg/mL/mo between 9 and 16 months, but decreased thereafter. Similar patterns were observed in analyses restricted to PWH who switched from TDF to TAF but maintained all other agents. Conclusions TDF-to-TAF switch was associated with LDL-C and TG increases over the first 9 to 16 months on TAF. The dynamic patterns observed cannot be attributed to changes in other agents.
Collapse
Affiliation(s)
- Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
19
|
Asif S, Baxevanidi E, Hill A, Venter WDF, Fairlie L, Masenya M, Serenata C, Sokhela S, Chandiwana N. The predicted risk of adverse pregnancy outcomes as a result of treatment-associated obesity in a hypothetical population receiving tenofovir alafenamide/emtricitabine/dolutegravir, tenofovir disoproxil fumarate/emtricitabine/dolutegravir or tenofovir disoproxil fumarate/emtricitabine/efavirenz. AIDS 2021; 35:S117-S125. [PMID: 34261099 DOI: 10.1097/qad.0000000000003020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Integrase inhibitors, including dolutegravir (DTG), are associated with weight gain and obesity, especially when combined with tenofovir alafenamide (TAF). Obesity increases the risk of adverse pregnancy outcomes (APOs). This study aimed to predict the risk of APOs caused by treatment-associated obesity, using a hypothetical sample based on the ADVANCE trial. DESIGN Risk prediction. METHODS Firstly, a meta-analysis was performed to determine the relative risk (RR) for APOs in women with obese (≥30) versus normal prepregnancy BMIs (18.5-24.9). For the hypothetical sample, 3000 nonpregnant women with normal BMIs at Week 0 of treatment were evenly allocated across the following treatment arms: TAF/FTC+DTG, TDF/FTC+DTG, TDF/FTC/EFV. The treatment-associated obesity rates from ADVANCE were used to calculate the number of women with obese and normal BMIs expected at Week 96 in our sample. This was combined with the APO RRs to predict the number of women at risk of APOs, in each treatment arm, assuming they conceived at Week 96. RESULTS At Week 96, the percentage of women predicted to be obese was 14.1% with TAF/FTC+DTG, 7.9% with TDF/FTC+DTG and 1.5% with TDF/FTC/EFV. The RR in women with obese versus normal BMIs was significantly higher for most APOs. Therefore, the number of women at risk of APOs was higher with TAF/FTC+DTG than TDF/FTC+DTG and TDF/FTC/EFV. For example, 11/1000 additional gestational hypertension cases were predicted with TAF/FTC+DTG, 6/1000 with TDF/FTC+DTG and 1/1000 with TDF/FTC/EFV. CONCLUSION Treatment-associated obesity increased the APO risk in women. This risk is likely to increase, as preliminary data from ADVANCE demonstrates ongoing weight gain beyond Week 96.
Collapse
Affiliation(s)
- Sumbul Asif
- Faculty of Medicine, Imperial College London, UK
| | | | - Andrew Hill
- Department of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Masebole Masenya
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celicia Serenata
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simiso Sokhela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
20
|
Wood BR, Huhn GD. Excess Weight Gain With Integrase Inhibitors and Tenofovir Alafenamide: What Is the Mechanism and Does It Matter? Open Forum Infect Dis 2021; 8:ofab542. [PMID: 34877366 PMCID: PMC8643706 DOI: 10.1093/ofid/ofab542] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
Numerous studies have detected a greater likelihood of excess weight gain with specific antiretrovirals (ARVs), particularly tenofovir alafenamide and integrase inhibitors, as compared with other agents and classes. The long-term implications and potential reversibility for individuals who have experienced substantial ARV-associated weight accumulation remain poorly understood. Furthermore, the underlying mechanism remains controversial: Is the explanation mitochondrial toxicity and weight suppression from the older agents or direct effects of the newer drugs on appetite, adipocytes, or other unintended targets? This review discusses proposed mechanisms and evidence to date and argues that the question about mechanism is highly clinically relevant because it carries significant implications for ARV management. The existing literature suggests that older ARVs, such as tenofovir disoproxil fumarate and efavirenz, suppress weight gain, but also that integrase inhibitors may stimulate excess weight gain through several plausible biologic pathways. Confirming the mechanisms of ARV-associated excess weight gain should be high priority for future research.
Collapse
Affiliation(s)
- Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gregory D Huhn
- Division of Infectious Diseases, Cook County Health, Chicago, Illinois, USA.,Division of Infectious Disesases, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
21
|
Contemporary antiretrovirals and body-mass index: a prospective study of the RESPOND cohort consortium. Lancet HIV 2021; 8:e711-e722. [PMID: 34555326 DOI: 10.1016/s2352-3018(21)00163-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight gain effects of individual antiretroviral drugs are not fully understood. We investigated associations between a prespecified clinically significant increase (>7%) in body-mass index (BMI) and contemporary antiretroviral use. METHODS The International Cohort Consortium of Infectious Diseases (RESPOND) is a prospective, multicohort collaboration, including data from 17 well established cohorts and over 29 000 people living with HIV. People with HIV under prospective follow-up from Jan 1, 2012, and older than 18 years were eligible for inclusion. Each cohort contributed a predefined minimum number of participants related to the size of the specific cohort (with a minimum of 1000 participants). Participants were required to have CD4 cell counts and HIV viral load measurement in the 12 months before or within 3 months after baseline. For all antiretroviral drugs received at or after RESPOND entry, changes from pre-antiretroviral BMI levels (baseline) were considered at each BMI measurement during antiretroviral treatment. We used logistic regression to identify individual antiretrovirals that were associated with first occurrence of a more than 7% increase in BMI from pre-antiretroviral BMI. We adjusted analyses for time on antiretrovirals, pre-antiretroviral BMI, demographics, geographical region, CD4 cell count, viral load, smoking status, and AIDS at baseline. RESULTS 14 703 people were included in this study, of whom 7863 (53·5%) had a more than 7% increase in BMI. Compared with lamivudine, use of dolutegravir (odds ratio [OR] 1·27, 95% CI 1·17-1·38), raltegravir (1·37, 1·20-1·56), and tenofovir alafenamide (1·38, 1·22-1·35) was significantly associated with a more than 7% BMI increase, as was low pre-antiretroviral BMI (2·10, 1·91-2·31 for underweight vs healthy weight) and Black ethnicity (1·61, 1·47-1·76 vs White ethnicity). Higher CD4 count was associated with a reduced risk of BMI increase (0·97, 0·96-0·98 per 100 cells per μL increase). Relative to lamivudine, dolutegravir without tenofovir alafenamide (OR 1·21, 95% CI 1·19-1·32) and tenofovir alafenamide without dolutegravir (1·33, 1·15-1·53) remained independently associated with a more than 7% increase in BMI; the associations were higher when dolutegravir and tenofovir alafenamide were used concomitantly (1·79, 1·52-2·11, and 1·70, 1·44-2·01, respectively). INTERPRETATION Clinicians and people with HIV should be aware of associations between weight gain and use of dolutegravir, tenofovir alafenamide, and raltegravir, particularly given the potential consequences of weight gain, such as insulin resistance, dyslipidaemia, and hypertension. FUNDING The CHU St Pierre Brussels HIV Cohort, The Austrian HIV Cohort Study, The Australian HIV Observational Database, The AIDS Therapy Evaluation in the Netherlands national observational HIV cohort, The EuroSIDA cohort, The Frankfurt HIV Cohort Study, The Georgian National AIDS Health Information System, The Nice HIV Cohort, The ICONA Foundation, The Modena HIV Cohort, The PISCIS Cohort Study, The Swiss HIV Cohort Study, The Swedish InfCare HIV Cohort, The Royal Free HIV Cohort Study, The San Raffaele Scientific Institute, The University Hospital Bonn HIV Cohort and The University of Cologne HIV Cohorts, ViiV Healthcare, and Gilead Sciences.
Collapse
|
22
|
Taramasso L, Bonfanti P, Ricci E, Maggi P, Orofino G, Squillace N, Menzaghi B, Madeddu G, Molteni C, Vichi F, Riguccini E, Saracino A, Santoro C, Guastavigna M, Francisci D, Di Biagio A, De Socio GV. Metabolic syndrome and body weight in people living with HIV infection: analysis of differences observed in three different cohort studies over a decade. HIV Med 2021; 23:70-79. [PMID: 34473897 DOI: 10.1111/hiv.13165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of being overweight and metabolic syndrome (MS) among people living with HIV (PHIV) in three different cross-sectional studies conducted over three different periods: 2005, 2011 and 2015. METHODS This was a multi-centre, nationwide study. Data were collected in three studies from the CISAI group - SIMOne, HIV-HY and STOPSHIV - and included a total of 3014 PHIV. Logistic regression [odds ratio (OR), 95% confidence interval (CI)] was used to account for age and gender difference among three groups when comparing MS prevalence and being overweight; potential confounders were accounted for by including them in the regression equation. RESULTS Overall, the mean age was 46.9 ± 10.2 years, and men comprised 73.3% of participants. Comparing 2005, 2011 and 2015, MS was present in 34.5%, 33.0% and 29.3% of PHIV, respectively. Adjusted OR for MS was 0.64 (95% CI: 0.52-0.78) in 2011 and 0.56 (95% CI: 0.46-0.69) in 2015 compared with 2005, while BMI (kg/m2 ) increased from 23.6 in 2005, 24.5 in 2011 and 24.5 in 2015, with a concomitant increase of being overweight from 29.4% to 39.5% to 39.6% (p < 0.0001). CONCLUSIONS In recent years, PHIV have had a significantly improved metabolic profile compared with previously, despite increasing weight and BMI.
Collapse
Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Clinic, Policlinico San Martino Hospital-IRCCS, Genoa, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Molteni
- Infectious Diseases Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Italy
| | - Erika Riguccini
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | | | - Carmen Santoro
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Marta Guastavigna
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Torino, Italy
| | - Daniela Francisci
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giuseppe Vittorio De Socio
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | | |
Collapse
|
23
|
Darnell J, Jain S, Sun X, Qin H, Reynolds T, Karris MY, Hill LA. Impact of switching to tenofovir alafenamide on weight gain as compared to maintaining a non-tenofovir alafenamide containing regimen. Medicine (Baltimore) 2021; 100:e27047. [PMID: 34449491 PMCID: PMC8389919 DOI: 10.1097/md.0000000000027047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
Evaluate the impact of switching to an anti-retroviral regimen containing tenofovir alafenamide (TAF) on weight and the development of metabolic complications compared to remaining on a non-TAF containing regimen.Single-center retrospective case-control study.We evaluated people living with human immunodeficiency virus (PLWH) who were on an anti-retroviral regimen not containing TAF and were switched to a regimen containing TAF between January 1, 2016 and September 30, 2018. The control group included PLWH on a TAF free regimen throughout the study period. The primary outcome was change in weight from baseline to 12 months postswitch. Secondary outcomes included percent change in weight, change in body mass index (BMI), change in BMI class, and new diagnoses of diabetes, hypertension, and hyperlipidemia (HLD) during the study period.PLWH switched to TAF (n = 446) demonstrated significantly greater mean increase in weight compared to the control group (n = 162) (1.97 vs 0.88 kg, P = .01), however the effect was only seen in those switched from tenofovir disoproxil fumarate. Those that switched to TAF also had a significantly higher percent increase in weight, increase in BMI, and BMI class. We observed a higher rate of new diagnosis of HLD in the control group compared to the TAF switch group during the study period.PLWH switched to TAF had greater increases in weight after 1 year as compared to those continuing on a TAF free regimen. However, this did not translate to higher rates of obesity related illnesses such as diabetes, hypertension, and HLD during the follow up period.
Collapse
Affiliation(s)
- Julia Darnell
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA
| | - Sonia Jain
- Herbert Wertheim School of Public Health, Biostatistics Research Center, UC San Diego, San Diego, CA
| | - Xiaoying Sun
- Herbert Wertheim School of Public Health, Biostatistics Research Center, UC San Diego, San Diego, CA
| | - Huifang Qin
- Department of Medicine, UC San Diego, San Diego, CA
| | - Timothy Reynolds
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA
| | - Maile Young Karris
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Lucas A. Hill
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA
| |
Collapse
|
24
|
Sjaarda A, Bernstein A, Sparks A, Saber S, Siegel M. Comparison of weight gain after antiretroviral switch to integrase strand transfer inhibitor or tenofovir alafenamide-based therapy. Infection 2021; 50:407-412. [PMID: 34449049 DOI: 10.1007/s15010-021-01687-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Several studies have reported weight gain after switching to integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART). Debate persists if weight gain also occurs when switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-based ART. METHODS We performed a retrospective chart review of virally suppressed HIV-infected patients who were switched from non INSTI- to INSTI-based ART (INSTI switch group) as well as patients switched from TDF- to TAF-based ART (TAF switch group), and compared the mean weight change in these groups to the mean change in weight in patients maintained on NNRTI-based regimens (control group). RESULTS 329 patients were identified. 256 patients in the INSTI switch group gained a mean 2.4 kg over 17 months compared to 0.5 kg in 54 patients in the control group over the same period (p = 0.008). 161 patients in the TAF switch group gained a mean 2.8 kg over 17 months compared to 0.5 kg in the control group (p = 0.003). There was no statistical difference in weight gain between the INSTI and TAF switch groups. Although the highest mean weight gain of 3.2 kg was seen in those 90 patients switched from both TDF- to TAF-based and non INSTI- to INSTI-based ART (TAF/INSTI switch group), this weight gain was not statistically different compared with the INSTI switch or TAF switch groups. CONCLUSION Our study suggests that weight gain is associated with both switching HIV regimens from non INSTI- to INSTI-based ART and TDF- to TAF-based ART.
Collapse
Affiliation(s)
- Alexandra Sjaarda
- The George Washington School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, USA
| | - Andrew Bernstein
- The George Washington School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, USA
| | - Andrew Sparks
- Department of Medicine, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Avenue, NW, Washington, DC, USA
| | - Saghar Saber
- St. John's Well Child and Family Center, 808 W 58th St, Los Angeles, CA, USA
| | - Marc Siegel
- Department of Medicine, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Avenue, NW, Washington, DC, USA. .,Division of Infectious Disease, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-436, Washington, DC, 20037, USA.
| |
Collapse
|
25
|
Goldberg RN, Kania AT, Michienzi SM, Patel M, Badowski ME. Weight Gain in Incarcerated Individuals Living With HIV After Switching to Integrase Strand Inhibitor-Based Therapy. J Int Assoc Provid AIDS Care 2021; 20:2325958221996860. [PMID: 33626965 PMCID: PMC7917853 DOI: 10.1177/2325958221996860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Post-marketing data have demonstrated the potential for weight gain with
integrase inhibitors (INSTI) use in antiretroviral (ART) therapy. Methods: A medical chart review evaluated virologically suppressed adult prisoners
living with HIV and on a non-INSTI regimen before switching or adding an
INSTI. Primary outcome assessed average weight change; Secondary outcomes
evaluated change in body mass index (BMI), fasting lipid panel, and
development of hypertension. Statistical analysis included paired t-tests
and descriptive statistics. Results: Among 103 study participants, 95% were men with a median age of 44 years.
Each INSTI was associated with an average weight increase of 4.3 kg (p <
0.025). Bictegravir and dolutegravir were also associated with significant
increases in BMI, +1.4kg/m2 and +2.8kg/m2,
respectively (p = 0.011 and p = 0.001). Conclusion: Patients receiving HIV care in a correctional setting and on INSTI-based
treatments experienced weight gain and increases in BMI. Future research
should focus on the mechanism of development and interventions to prevent
weight gain.
Collapse
Affiliation(s)
- Rachel N Goldberg
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexandra T Kania
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah M Michienzi
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, Chicago, IL, USA
| | - Mahesh Patel
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa E Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, Chicago, IL, USA
| |
Collapse
|
26
|
Lei JJH, Pereira B, Moyle G, Boffito M, Milinkovic A. The benefits of tenofovir discontinuation with or without bisphosphonate therapy in osteoporotic people living with HIV. HIV Med 2021; 22:816-823. [PMID: 34258828 DOI: 10.1111/hiv.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Treatment with bisphosphonates and discontinuation of tenofovir disoproxil fumarate (TDF) are recommended strategies for managing osteoporosis in people living with HIV (PLHIV). This study aimed to compare the effects on bone mineral density (BMD) of TDF discontinuation with and without bisphosphonate therapy in osteoporotic PLHIV. METHODS The present study is a retrospective cohort analysis of dual-energy X-ray absorptiometry scan results of PLHIV attending Chelsea and Westminster Hospital HIV clinic between 2009 and 2020. Osteoporotic (T-score < -2.5) patients with ≥ 6 months' TDF exposure were included. Changes in BMD and T-scores at the lumbar spine (LS) and femoral neck (FN) were assessed. RESULTS A total of 84 participants were included, of whom 43 discontinued TDF only (TS) and 41 switched from TDF and received bisphosphonates (TS+): 86.9% were male; 77.4% were white; median (interquartile range, IQR) age was 54.8 (51.0-58.5) years; and median (IQR) TDF exposure was 6.5 (3.5-10.4) years. At a median follow-up of 2 years after TDF-discontinuation, mean spine BMD increased significantly in both groups, but bisphosphonate recipients had greater improvements (4.83% vs. 7.79%; P < 0.019); LS T-scores improved significantly but changes were comparable between groups (TS, 0.5 vs. TS+, 0.6; P = 0.270). At the FN, no significant increases in BMD were observed (TS, 3.05% vs. TS+, 2.71%; P = 0.205); T-scores significantly improved in bisphosphonate recipients only (+0.2; P = 0.003). A greater proportion recovered from osteoporosis in the TS+ group (34.9% vs. 43.9%), although differences between groups were not significant (P = 0.503). CONCLUSIONS Our real-world data indicate that although TDF discontinuation significantly improved bone health in osteoporotic PLHIV, combining bisphosphonates with TDF discontinuation resulted in greater improvements in BMD.
Collapse
Affiliation(s)
| | - Branca Pereira
- Imperial College London, London, UK.,HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Graeme Moyle
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Marta Boffito
- Imperial College London, London, UK.,HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ana Milinkovic
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
27
|
Emond B, Rossi C, Côté-Sergent A, Dunn K, Lefebvre P, Lafeuille MH, Donga P. Weight Change and Predictors of Weight Change Among Patients Initiated on Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide or Bictegravir/Emtricitabine/Tenofovir Alafenamide: A Real-World Retrospective Study. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:88-98. [PMID: 34179212 PMCID: PMC8203466 DOI: 10.36469/001c.24535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/13/2021] [Indexed: 06/13/2023]
Abstract
Background: Recent evidence suggests that integrase strand transfer inhibitors are associated with greater weight gain than protease inhibitors in patients with human immunodeficiency virus (HIV-1). Objectives: To describe demographic and clinical characteristics of insured patients with HIV-1 in the United States initiating darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/FTC/TAF) or bictegravir/FTC/TAF (BIC/FTC/TAF), assess the differences in weight and body mass index (BMI) change between cohorts up to one year after treatment initiation, and identify the predictors of weight gain associated with each treatment. Methods: The Symphony Health, IDV® database (July 17, 2017 - September 30, 2019) was used to identify treatment naïve or virologically suppressed stable switchers who initiated DRV/c/FTC/TAF or BIC/FTC/TAF (index date) on or after July 17, 2018, were ≥18 years of age on the index date, and had ≥12 months of continuous clinical activity pre-index (baseline period). To account for differences in baseline characteristics, inverse-probability of treatment weighting (IPTW) was used. Mean weight and BMI change from pre- to post-index measurements were compared between weighted cohorts at 3, 6, 9, and 12 months post-index using mean differences. Predictors of weight or BMI gain ≥5% were evaluated at last measurement, for each treatment cohort separately. Results: After IPTW, 452 and 497 patients were included in the DRV/c/FTC/TAF and BIC/FTC/TAF cohorts, respectively. Baseline characteristics were generally well-balanced (mean age=~50 years, female: ~30%), except for the type of antiretroviral therapy from which patients switched. Patients initiated on BIC/FTC/TAF experienced greater weight and BMI increases between the pre-index period and each measurement of the post-index period than patients initiated on DRV/c/FTC/TAF, although results were only statistically significant at 9 months post-index (weight: mean difference=2.50 kg, P=0.005; BMI: mean difference=0.66 kg/m2, P=0.027). A common predictor of weight or BMI gain ≥5% among patients in both cohorts was female gender (DRV/c/FTC/TAF: odds ratio [OR]=5.92, P=0.014; BIC/FTC/TAF: OR=2.00, P<0.001). Conclusion: Patients in the BIC/FTC/TAF cohort experienced greater weight and BMI increases than patients in the DRV/c/FTC/TAF cohort, with differences reaching statistical significance at 9 months post-index. Weight gain is an important factor to consider when selecting antiretroviral regimens, since it is associated with long-term health consequences. Future studies with larger sample size and longer follow-up time are warranted.
Collapse
|
28
|
Surial B, Mugglin C, Calmy A, Cavassini M, Günthard HF, Stöckle M, Bernasconi E, Schmid P, Tarr PE, Furrer H, Ledergerber B, Wandeler G, Rauch A. Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV : A Cohort Study. Ann Intern Med 2021; 174:758-767. [PMID: 33721521 DOI: 10.7326/m20-4853] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain. OBJECTIVE To assess weight changes, the development of overweight/obesity, and changes in lipid levels 18 months after replacing TDF with TAF. DESIGN Cohort study. SETTING 5 university hospitals, affiliated hospitals, and private physicians in Switzerland. PARTICIPANTS 4375 adults living with HIV who received TDF-containing ART for 6 months or longer. MEASUREMENTS Changes in weight and lipid levels were assessed using mixed-effect models. Differences in proportions of newly overweight/obese participants were calculated using 2-proportions Z tests. RESULTS 4375 individuals were included, with follow-up between 1 January 2016 and 31 July 2019. Median age was 50 years (interquartile range, 43 to 56 years), 25.9% were female, and 51.7% had a normal body mass index (BMI); 3484 (79.6%) switched to TAF and 891 (20.4%) continued TDF. After 18 months, switching to TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5 to 2.0 kg), compared with 0.7 kg (CI, 0.4 to 1.0 kg) with the continued use of TDF (between-group difference, 1.1 kg [CI, 0.7 to 1.4 kg]). Among individuals with a normal BMI, 13.8% who switched to TAF became overweight/obese, compared with 8.4% of those continuing TDF (difference, 5.4 percentage points [CI, 2.1 to 8.8 percentage points]). Switching to TAF led to increases in adjusted mean total cholesterol (0.25 mmol/L [9.5 mg/dL]), high-density lipoprotein cholesterol (0.05 mmol/L [1.9 mg/dL]), low-density lipoprotein cholesterol (0.12 mmol/L [4.7 mg/dL]), and triglyceride (0.18 mmol/L [16.1 mg/dL]) levels after 18 months. LIMITATION Short follow-up, small subgroup analyses, and potential residual confounding. CONCLUSION Replacing TDF with TAF is associated with adverse metabolic changes, including weight increase, development of obesity, and worsening serum lipid levels. PRIMARY FUNDING SOURCE Swiss National Science Foundation.
Collapse
Affiliation(s)
- Bernard Surial
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Catrina Mugglin
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Alexandra Calmy
- Geneva University Hospital, University of Geneva, Geneva, Switzerland (A.C.)
| | - Matthias Cavassini
- University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland (M.C.)
| | - Huldrych F Günthard
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Marcel Stöckle
- University Hospital Basel, University of Basel, Basel, Switzerland (M.S.)
| | - Enos Bernasconi
- Regional Hospital of Lugano, University of Geneva, and University of Southern Switzerland, Lugano, Switzerland (E.B.)
| | - Patrick Schmid
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland (P.S.)
| | - Philip E Tarr
- and Kantonsspital Baselland, University of Basel, Basel, Switzerland (P.E.T.)
| | - Hansjakob Furrer
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Bruno Ledergerber
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Gilles Wandeler
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Andri Rauch
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | | |
Collapse
|
29
|
Lahiri CD, Xu Y, Wang K, Alvarez JA, Sheth AN, O'Halloran J, Spence AB, Tien P, Gustafson DR, Milam J, Fischl MA, Konkle-Parker D, Adimora AA, Sharma A, Weber KM, Ofotokun I, Rubin LH. Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV. AIDS Res Hum Retroviruses 2021; 37:461-467. [PMID: 33231474 PMCID: PMC8213005 DOI: 10.1089/aid.2020.0197] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Weight and body mass index (BMI) change was assessed among women after switch to integrase inhibitors (INSTIs) and/or tenofovir alafenamide (TAF). From 2006 to 2019, 1,458 women living with HIV enrolled in the Women's Interagency HIV Study and on antiretroviral therapy (ART) with ≥1 study visit before and after switching to INSTIs and/or TAF were included. Weight and BMI were compared pre- and postswitch to INSTI (by class and type) and/or TAF using multivariable linear mixed effects models; all models were also stratified by preswitch presence or absence of obesity (BMI ≥30 vs. <30 kg/m2). Mean age preswitch was 47 ± 6 years, 64% were black, mean CD4 = 475 ± 201 cells/mm3, 56% had HIV RNA <200 copies/mL, 36% switched to TAF but not INSTI, 60% to INSTI but not TAF, and 3.5% to TAF+INSTI. Time from pre- to postswitch was 12.8 ± 11.8 months. The INSTI-only group but not TAF groups had small but significant increases in weight and BMI: mean 79.2-80.6 kg and 30.2-30.7 kg/m2, p's < .001, respectively, with congruent findings by INSTI type (p's ≤ .01). In stratified (preswitch BMI) analyses, only nonobese subgroups experienced increases in weight and BMI across all ART treatment groups (p's < .05). Significant, although small-to-medium, increases in weight and BMI occurred among nonobese women who switched to INSTIs and/or TAF over short follow-up. Given long-term health consequences of obesity particularly as a low-grade inflammatory condition, identifying women at highest risk of ART-associated weight gain is imperative.
Collapse
Affiliation(s)
- Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Biostatistics and Bioinformatics at the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jane O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Amanda B. Spence
- Division of Infectious Disease and Travel Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Phyllis Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York, New York, USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California, USA
| | - Margaret A. Fischl
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Kathleen M. Weber
- CORE Center, Cook County Health, Chicago, Illinois, USA
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
30
|
Erlandson KM, Carter CC, Melbourne K, Brown TT, Cohen C, Das M, Esser S, Huang H, Koethe JR, Martin H, McComsey GA, Orkin C, Post FA, Rockstroh JK, Sax PE, Stellbrink HJ, Waters L, Wei X, Lake JE. Weight Change Following Antiretroviral Therapy Switch in People with Viral Suppression: Pooled Data from Randomized Clinical Trials. Clin Infect Dis 2021; 73:1440-1451. [PMID: 33987636 DOI: 10.1093/cid/ciab444] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We sought to identify factors associated with weight gain in randomized clinical trials of antiretroviral (ART) switch. METHODS We explored the effects of demographic factors, clinical characteristics, and ART on weight gain in a pooled analysis of 12 prospective clinical trials, wherein virologically-suppressed people with HIV (PWH) were randomized to switch or remain on stable baseline regimen (SBR). RESULTS Both PWH randomized to switch ART (n=4,166) and those remaining on SBR (n=3150) gained weight. Median weight gain was greater in those who switched (1.6 [IQR -.05, 4.0] vs 0.4 [IQR -1.8, 2.4] kg at 48 weeks, p<0.0001), with most weight gain occurring in the first 24 weeks after switch. Among baseline demographic and clinical characteristics, only younger age and lower baseline body mass index were associated with any or ≥10% weight gain. 4.6% gained ≥10% weight by week 48 (6.4% of switch and 2.2% of SBR), the greatest risk with switch from EFV to RPV or EVG/c, and switch from TDF to TAF. Switch from ABC to TAF was associated with less weight gain than switch from TDF to TAF, and was not associated with increased risk for ≥10% weight gain. CONCLUSIONS Moderate weight gain after ART switch was common, and usually plateaued by 48 weeks. Baseline ART was a predictor of post-switch weight gain: participants switching off EFV and TDF had the greatest weight gain. The biological mechanisms underlying the differential effects of switching ART agents on weight and associated clinical implications require further study.
Collapse
Affiliation(s)
| | | | | | | | - Cal Cohen
- Gilead Sciences, Inc.; Foster City, CA; USA
| | | | | | | | - John R Koethe
- Vanderbilt University Medical Center; Nashville, TN; USA
| | - Hal Martin
- Gilead Sciences, Inc.; Foster City, CA; USA
| | - Grace A McComsey
- University Hospitals Health System; Cleveland, OH; USA.,Case Western Reserve University; Cleveland, OH; USA
| | - Chloe Orkin
- Barts Health National Health Service Trust; London, UK
| | - Frank A Post
- King's College Hospital National Health Service Foundation Trust; London, UK
| | | | - Paul E Sax
- Brigham and Women's Hospital; Harvard Medicine School, Boston, MA; USA
| | | | | | | | - Jordan E Lake
- University of Texas Health Science Center; Houston, TX; USA
| |
Collapse
|
31
|
Martínez‐Sanz J, Blanco J, Muriel A, Pérez‐Elías MJ, Rubio‐Martín R, Berenguer J, Peraire J, Bernal E, Martínez OJ, Serrano‐Villar S, Moreno S. Weight changes after antiretroviral therapy initiation in CoRIS (Spain): a prospective multicentre cohort study. J Int AIDS Soc 2021; 24:e25732. [PMID: 34036745 PMCID: PMC8150051 DOI: 10.1002/jia2.25732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Weight gain after starting antiretroviral therapy (ART) is a major problem that can increase morbidity. Our main objective was to evaluate the effects of initial ART on weight change in a large prospective cohort of HIV-positive individuals. METHODS This was a prospective cohort study of 13,198 subjects included in the Spanish HIV Research Network (CoRIS) between January 2004 and November 2018. We included subjects who started triple ART and achieved HIV RNA suppression within 48 weeks. We fitted linear mixed models adjusted for potential confounders to compare longitudinal changes in weight. We used Cox proportional-hazard models to compare treatment groups' times to transition to a higher body mass index (BMI) category. RESULTS We analysed data from a total of 1631 individuals resulting in 14,965 persons/years and 14,085 observations. Individuals retained in the final multivariable model were representative of the overall cohort. NNRTI-based first-line ART was associated with a lower average weight gain compared to PI- (+0.7 kg per year, 95% CI 0.5 to 1.0, p < 0.001) and INSTI-based (+0.9 kg per year, 95% CI 0.7 to 1.1, p < 0.001) regimens. Individuals starting ART with TAF+FTC had greater weight gain than those receiving TDF+FTC (+0.8 kg per year, 95% CI 0.3 to 1.4, p = 0.004). Women and black persons presented a greater weight gain than men and non-black individuals. Differences in weight trajectories were driven mainly by changes during the first year of ART. The NNRTI group was less likely to transition from normal weight to overweight than the PI (aHR 1.48, 95% CI 1.18 to 1.85) and INSTI groups (aHR 1.30, 95% CI 1.03 to 1.64). PIs but not INSTIs were associated with a higher rate of overweight-to-obesity shift (aHR 2.17, 95% CI 1.27 to 3.72). No differences were found among INSTIs in the transition to a higher BMI category. CONCLUSIONS INSTI- and PI-based first-line ARTs are associated with greater weight gain compared to NNRTI-based ART. Within the NRTIs, TAF+FTC was most strongly associated with weight gain. This heterogeneous effect of ART on body weight could affect the long-term risk of some non-communicable diseases.
Collapse
Affiliation(s)
- Javier Martínez‐Sanz
- Department of Infectious DiseasesHospital Universitario Ramón y CajalIRYCISMadridSpain
| | - José‐Ramón Blanco
- Department of Infectious DiseasesHospital San PedroCentro de Investigación Biomédica de La Rioja (CIBIR)LogroñoSpain
| | - Alfonso Muriel
- Clinical Biostatistic UnitDepartamento de Enfermería y FisioterapiaHospital Universitario Ramón y CajalUniversidad de AlcaláIRYCISCIBERESPMadridSpain
| | | | | | - Juan Berenguer
- Hospital General Universitario Gregorio MarañónMadridSpain
| | - Joaquim Peraire
- Hospital Universitari de Tarragona Joan XXIIIIISPVUniversitat Rovira i VirgiliTarragonaSpain
| | | | | | - Sergio Serrano‐Villar
- Department of Infectious DiseasesHospital Universitario Ramón y CajalIRYCISMadridSpain
| | - Santiago Moreno
- Department of Infectious DiseasesHospital Universitario Ramón y CajalIRYCISMadridSpain
| | | |
Collapse
|
32
|
Kovari H, Surial B, Tarr PE, Cavassini M, Calmy A, Schmid P, Bernasconi E, Rauch A, Wandeler G, Ledergerber B. Changes in alanine aminotransferase levels after switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) in HIV-positive people without viral hepatitis in the Swiss HIV Cohort Study. HIV Med 2021; 22:623-628. [PMID: 33880839 DOI: 10.1111/hiv.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We previously demonstrated an association between tenofovir disoproxil fumarate (TDF) and chronic liver enzyme elevation in the D:A:D study. The objective of the study was to assess changes in alanine aminotransferase (ALT) levels after switching from TDF to tenofovir alafenamide (TAF). METHODS We included Swiss HIV Cohort Study participants who switched from TDF to TAF with two or more ALT values in the 24 months before and two or more values in the 24 months after replacing TDF with TAF. Individuals with replicating viral hepatitis were excluded. Uni- and multivariable linear mixed models were used to explore changes in ALT values associated with switching from TDF to TAF, and to assess potential modifying effects. RESULTS A total of 1712 participants were included, contributing 6169 ALT values before and 5482 after switching. Median (interquartile range, IQR) age was 50 (42-57) years, and 75% were male. Median (IQR) ALT was 28 (22-38) U/L before and 24 (19-32) U/L after replacing TDF with TAF. ALT values decreased by 3.7 U/L (95% confidence interval: 3.2-4.2) after the switch. The median drop was larger in patients with chronic ALT elevation (defined as two or more elevated values for ≥ 6 months) compared with patients with normal ALT values (17.8 vs. 3.3 U/L, P < 0.001). We did not identify any major effect modifications of the ALT change with any of the potential variables studied. CONCLUSIONS Replacing TDF with TAF in HIV-monoinfected people led to a significant decrease in ALT values. Findings were not significantly affected by known risk factors for hepatotoxicity.
Collapse
Affiliation(s)
- H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
| | - B Surial
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - P E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - M Cavassini
- Division of Infectious Diseases, University Hospital, Lausanne, Switzerland
| | - A Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - P Schmid
- Division of Infectious Diseases, Cantonal Hospital, St Gall, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Ospedale Regionale, Lugano, Switzerland
| | - A Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
33
|
Mallon PW, Brunet L, Hsu RK, Fusco JS, Mounzer KC, Prajapati G, Beyer AP, Wohlfeiler MB, Fusco GP. Weight gain before and after switch from TDF to TAF in a U.S. cohort study. J Int AIDS Soc 2021; 24:e25702. [PMID: 33838004 PMCID: PMC8035674 DOI: 10.1002/jia2.25702] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction Although weight gain has been reported with the use of integrase strand transfer inhibitors (InSTI), concurrent use of tenofovir alafenamide (TAF) has been implicated in recent studies. This study examined weight changes in people living with HIV (PLWH) who switched from tenofovir disoproxil fumarate (TDF) to TAF, to clarify the relative contribution to weight gain of core agents versus TDF to TAF switch. Methods Antiretroviral‐experienced, virologically suppressed PLWH in the U.S. OPERA cohort were included if they switched from TDF to TAF (5NOV2015‐28FEB2019) and either maintained all other antiretrovirals or switched from a non‐InSTI to an InSTI. Linear mixed models were used to assess weight changes before/after the switch to TAF (restricted cubic splines on time) and rates of change over time (linear splines on time, based on the shape of the weight change curves). Changes in weight on TDF or TAF were assessed among those who maintained other antiretrovirals (overall, by core class), and those who maintained an InSTI or switched to an InSTI (by core agent). All models were adjusted for age, sex, race, (age‐sex, race‐sex interactions), BMI, CD4 cell count, endocrine disorders and concurrent medications that could affect weight. Results A total of 6908 PLWH were included, with 5479 maintaining all other antiretrovirals (boosted protease inhibitor: 746, non‐nucleoside reverse transcriptase inhibitor: 1452, InSTI: 3281) and 1429 switching from a non‐InSTI to an InSTI (elvitegravir/cobicistat: 1120, dolutegravir: 174, bictegravir: 129). In adjusted models, modest weight gain was observed over time on TDF for most (0.24 to 0.71 kg/year); raltegravir was the exception with weight loss. Switching to TAF was associated with early, pronounced weight gain for all (1.80 to 4.47 kg/year). This effect with TAF switch was observed both in PLWH maintaining other antiretrovirals and those switching to an InSTI, regardless of which InSTI agent was used. Weight gain tended to slow down or plateau approximately nine months after switch to TAF. Conclusions In this large, diverse U.S. cohort of PLWH, switching from TDF to TAF was associated with pronounced weight gain immediately after switch, regardless of the core class or core agent, suggesting an independent effect of TAF on weight gain.
Collapse
Affiliation(s)
- Patrick Wg Mallon
- Centre for Experimental Pathogen Host Research, School of Medicine, University College Dublin, Dublin, Ireland.,St Vincent's University Hospital, Dublin, Ireland
| | | | - Ricky K Hsu
- AIDS Healthcare Foundation, New York, NY, USA.,NYU Langone Medical Center, New York, NY, USA
| | | | | | | | | | | | | |
Collapse
|
34
|
Sano T, Kawaguchi T, Ide T, Amano K, Kuwahara R, Arinaga-Hino T, Torimura T. Tenofovir Alafenamide Rescues Renal Tubules in Patients with Chronic Hepatitis B. Life (Basel) 2021; 11:life11030263. [PMID: 33806752 PMCID: PMC8005189 DOI: 10.3390/life11030263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 12/18/2022] Open
Abstract
Nucles(t)ide analogs (NAs) are effective for chronic hepatitis B (CHB). NAs suppress hepatic decompensation and hepatocarcinogenesis, leading to a dramatic improvement of the natural course of patients with CHB. However, renal dysfunction is becoming an important issue for the management of CHB. Renal dysfunction develops in patients with the long-term treatment of NAs including adefovir dipivoxil and tenofovir disoproxil fumarate. Recently, several studies have reported that the newly approved tenofovir alafenamide (TAF) has a safe profile for the kidney due to greater plasma stability. In this mini-review, we discuss the effectiveness of switching to TAF for NAs-related renal tubular dysfunction in patients with CHB.
Collapse
|
35
|
Kanda N, Okamoto K, Okumura H, Mieno M, Sakashita K, Sasahara T, Hatakeyama S. Outcomes associated with treatment change from tenofovir disoproxil fumarate to tenofovir alafenamide in HIV-1-infected patients: a real-world study in Japan. HIV Med 2021; 22:457-466. [PMID: 33720508 PMCID: PMC8251761 DOI: 10.1111/hiv.13061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the impact of switching from tenofovir disoproxil fumarate (TDF)- to tenofovir alafenamide (TAF)-containing regimens on bone, kidney, serum lipids and body weight among Asian patients. METHODS A prospective, multicentre, observational cohort study was conducted at three centres for HIV infection in Japan during 2017-2019. HIV-infected adults previously treated with TDF-containing regimens and scheduled to switch to TAF-containing regimens were included. Bone mineral density (BMD), renal markers, lipids and weight were measured consecutively from 12 months before to 12 months after the switch. RESULTS Among 118 patients evaluated, the mean percentage change to spine BMD during 1 year of TAF treatment was higher than that during 1 year of TDF treatment (mean difference = 1.9%; 95% confidence interval (CI): 0.8-3.1). Urine protein and β2 -microglobulin levels decreased significantly after the switch, while low-density lipoprotein cholesterol and triglycerides increased. During the TDF and TAF periods, the mean weight gains were 0.2 and 1.9 kg, respectively (mean difference = 1.6 kg; 95% CI: 0.9-2.3). Subgroup analysis revealed a significant difference between the mean body weight change associated with an integrase inhibitor (INSTI) (+2.8 kg) and that associated with a non-INSTI (+1.2 kg) third agent treatment only during the TAF period. CONCLUSIONS Among predominantly Japanese HIV-infected patients, BMD and renal tubular markers improved, while lipid profiles worsened significantly after the switch. Weight gain during the TAF period was larger than that during the TDF period. Concurrent use of INSTI with TAF may act synergistically to gain body weight.
Collapse
Affiliation(s)
- Naoki Kanda
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - Koh Okamoto
- Department of Internal Medicine, Tokyo Metropolitan Health and Medical Treatment Corporation Okubo Hospital, Tokyo, Japan.,Department of Infectious Diseases, University of Tokyo Hospital, Tokyo, Japan
| | - Hisatoshi Okumura
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Kentaro Sakashita
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Teppei Sasahara
- Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan
| | - Shuji Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan.,Department of Internal Medicine, Tokyo Metropolitan Health and Medical Treatment Corporation Okubo Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan
| |
Collapse
|
36
|
Łomiak M, Stępnicki J, Mikuła T, Wiercińska-Drapało A. Weight and body mass index increase after switch from tenofovir disoproxil fumarate to tenofovir alafenamide fumarate-containing treatment in an antiretroviral therapy-experienced group. Int J STD AIDS 2021; 32:570-577. [PMID: 33612018 DOI: 10.1177/0956462420983699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tenofovir alafenamide fumarate (TAF) is an alternative to tenofovir disoproxil fumarate (TDF). Currently, TAF is increasingly being used because of its non-inferior antiviral properties, lower risk of nephrotoxicity, and lower decrease in bone mineral density than TDF. There is growing evidence of unfavorable effects of TAF on weight and body mass index (BMI) in antiretroviral therapy (ART)-experienced patients treated with TAF-based ART. The aim of this study was to evaluate whether switching from TDF-containing to TAF-containing ART is associated with an increase in BMI and body weight in ART-experienced patients. Two study groups were established: 32 patients who switched from TDF to TAF only and 68 patients who switched from TDF to TAF along with changes to other components of the ART regimen. Significant weight gain and BMI increase was observed during the first year after initiation of TAF-containing ART regimens in both groups (mean change +1.91 kg and +0.61 kg/m2 in the first group and +1.50 kg and +0.49 kg/m2 in the second group). During the second year of TAF-based treatment, a sustained trend of body weight and BMI increase was noted only in the second group (mean change +1.46 kg, + 0.46 kg/m2). Analysis of body weight changes in certain subpopulations from the second group (selected based on patients' baseline characteristics) revealed a significant weight gain within two years after the switch in patients over 50 years old and in those whose ART had lasted longer than 10 years. These findings suggest that a possible impact of TAF on weight gain should be taken into account when selecting ART components, especially in older patients or those with a long history of antiretroviral treatment.
Collapse
Affiliation(s)
- Michał Łomiak
- Students Science Society of the Department of Infectious and Tropical Diseases and Hepatology, 162259Medical University of Warsaw, Poland
| | - Jan Stępnicki
- Students Science Society of the Department of Infectious and Tropical Diseases and Hepatology, 162259Medical University of Warsaw, Poland
| | - Tomasz Mikuła
- Department of Infectious and Tropical Diseases and Hepatology, 162259Medical University of Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, 162259Medical University of Warsaw, Poland
| |
Collapse
|
37
|
Shah S, Hindley L, Hill A. Are New Antiretroviral Treatments Increasing the Risk of Weight Gain? Drugs 2021; 81:299-315. [PMID: 33400239 DOI: 10.1007/s40265-020-01457-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a growing body of evidence from both observational and randomised trials implicating integrase inhibitors, particularly dolutegravir and bictegravir, with the development of weight gain and obesity in people living with HIV. Evidence with cabotegravir, the newest integrase inhibitor, is limited. Reasons for weight gain are currently unknown. Proposed mechanisms include improved tolerability, direct impact on adipogenesis, and gut microbiome disturbance. Clinical trials have found that weight gain with integrase inhibitors is greatest for women and people of Black ethnicity. Evidence suggests that the nucleoside reverse transcriptase backbone has additional effects on weight gain, with tenofovir alafenamide potentially enhancing the weight gain effect. Weight gain and obesity have long-term consequences, including metabolic syndrome, development of type 2 diabetes mellitus, cardiovascular disease and adverse birth outcomes. However, the current evidence for the medium and long-term effects of weight gain associated with integrase inhibitors is limited. There is an urgent need for clinical trials with longer follow-up periods and standardised endpoints to evaluate these effects. New thresholds for weight gain should be established as guidance for clinicians to stop treatment where weight gain is excessive. Novel treatments such as doravirine could offer a suitable therapy alternative, with current evidence showing efficacy with limited effect on weight gain.
Collapse
Affiliation(s)
- Shahini Shah
- Faculty of Medicine, Imperial College London, London, UK.
| | - Laura Hindley
- School of Public Health, Imperial College London, London, UK
| | - Andrew Hill
- Department of Translational Medicine, Liverpool University, Pharmacology, Liverpool, UK
| |
Collapse
|
38
|
Wu KS, Anderson C, Little SJ. Integrase Strand Transfer Inhibitors Play the Main Role in Greater Weight Gain Among Men With Acute and Early HIV Infection. Open Forum Infect Dis 2020; 8:ofaa619. [PMID: 33511237 PMCID: PMC7813183 DOI: 10.1093/ofid/ofaa619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background The predictors of weight gain remain unclear in people with acute and early HIV infection (AEH). Methods Eligible antiretroviral-naïve men diagnosed with AEH from January 1, 2000, to December 31, 2019, were enrolled in an observational cohort study at the University California, San Diego. The study used multivariable mixed-effect linear regression models to analyze differences in the rate of weight gain over time between participants receiving early vs deferred antiretroviral therapy (ART) treatment, low vs high baseline CD4 count and HIV RNA, and different classes of ART. Results A total of 463 participants were identified, with mean CD4 cell count of 507 cells/μL and log HIV RNA of 5.0 copies/mL at study entry. There was no difference in the rate of weight gain between participants who did and did not receive ART within 96 weeks of incident HIV infection. Neither a baseline CD4 count of <350 cells/μL nor a baseline HIV RNA of >100 000 copies/mL was a predictor of weight gain. Compared with persons taking non-nucleoside reverse transcriptase inhibitor-based regimens, those who received integrase strand transfer inhibitor (INSTI)-based regimens showed greater weight gain over time. Conclusions Neither baseline CD4 count and HIV RNA nor early ART was associated with weight change in the first 96 weeks following incident HIV infection. Use of INSTI-based regimens represented a major driver of weight gain in men who initiated ART with relatively higher CD4 cell counts.
Collapse
Affiliation(s)
- Kuan-Sheng Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Christy Anderson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| |
Collapse
|
39
|
Lee BT, Chang M, Lim C, Bae HS, Fong TL. Bone and renal safety profile at 72 weeks after switching to tenofovir alafenamide in chronic hepatitis B patients. JGH OPEN 2020; 5:258-263. [PMID: 33553665 PMCID: PMC7857293 DOI: 10.1002/jgh3.12481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
Background and Aim Tenofovir disoproxil fumarate (TDF) has been efficacious in treating chronic hepatitis B (CHB), but long-term use is accompanied by a decline in renal function and bone mineral density (BMD). Tenofovir alefanamide (TAF) is a prodrug of tenofovir, with similar efficacy in CHB but with fewer side effects than TDF. Recent studies on patients who underwent the switch from TDF to TAF have shown improved bone and renal profiles from 24 to 48 weeks of follow-up. Methods This study provides follow-up at 72 weeks in a real-world cohort of 61 Asian CHB patients who were switched from TDF to TAF. All patients had been treated with TDF for at least 12 months with hepatitis B virus DNA <21 IU/mL prior to switch. Results Improvements in proximal tubular function, measured by urine beta-2-microglobulin to creatinine and retinol-binding protein to creatinine ratios, were sustained at 72 weeks (P < 0.01). Renal function showed decline at 72 weeks compared to baseline (GFRCG 90.9 vs 96.3 mL/min, P < 0.01). Improvement in hip BMD was sustained at 72 weeks (mean % change of 17.7% from baseline, P < 0.01). However, spine BMD showed discordance, with initial improvement at 24 weeks (3.3% from week 0, P < 0.01) but regression at 72 weeks (-0.6% from week 0, P = NS). Interestingly, there was a slight increase in weight and BMI after 72 weeks (P < 0.01). Conclusions CHB patients who switch from long-term TDF to TAF therapy show sustained improvement in proximal tubular function and hip BMD. Weight gain was noted, and long-term studies are needed to evaluate its effect on patient outcomes.
Collapse
Affiliation(s)
- Brian T Lee
- Asian Pacific Liver Center at Saint Vincent Medical Center Los Angeles California USA.,Division of Gastrointestinal and Liver Diseases Keck School of Medicine at University of Southern California Los Angeles California USA
| | - Mimi Chang
- Asian Pacific Liver Center at Saint Vincent Medical Center Los Angeles California USA
| | - Carolina Lim
- Asian Pacific Liver Center at Saint Vincent Medical Center Los Angeles California USA
| | - Ho S Bae
- Asian Pacific Liver Center at Saint Vincent Medical Center Los Angeles California USA
| | - Tse-Ling Fong
- Asian Pacific Liver Center at Saint Vincent Medical Center Los Angeles California USA.,Division of Gastrointestinal and Liver Diseases Keck School of Medicine at University of Southern California Los Angeles California USA
| |
Collapse
|
40
|
Selvaraj SV, Bares SH, Havens JP. Acute Weight Gain After Switch to Emtricitabine/Tenofovir Alafenamide for Human Immunodeficiency Virus Pre-Exposure Prophylaxis. Open Forum Infect Dis 2020; 7:ofaa454. [PMID: 33134420 PMCID: PMC7588108 DOI: 10.1093/ofid/ofaa454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of acute weight gain after switching from emtricitabine/tenofovir disoproxil to emtricitabine/tenofovir alafenamide for human immunodeficiency virus pre-exposure prophylaxis.
Collapse
Affiliation(s)
- Shailendra V Selvaraj
- Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sara H Bares
- Department of Internal Medicine, Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Joshua P Havens
- Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Internal Medicine, Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
41
|
Switching to Integrase Inhibitors Unlinked to Weight Increase in Perinatally HIV-Infected Young Adults and Adolescents: A 10-Year Observational Study. Microorganisms 2020; 8:microorganisms8060864. [PMID: 32521616 PMCID: PMC7356820 DOI: 10.3390/microorganisms8060864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
An unexpected increase in weight gain has recently been reported in the course of integrase strand transfer inhibitors (INSTI) treatment. The possibility of this effect in people who are perinatally infected with HIV (PHIV) and thus exposed to lifelong therapy needs to be explored. This is a retrospective multicenter case-control study. Adults with PHIV followed between 2010 and 2019 in two outpatient services in Northern Italy were included if they had at least two weight measures in two successive years of observation. Patients were considered as cases if they were switched to INSTI (INSTI group), or controls if they were never exposed to INSTI (non-INSTI group). The date of the switch in cases was considered to be the baseline (T0), while it was randomly selected in controls. Mixed effect models were used to assess the weight changes in INSTI and non-INSTI groups. A total of 66 participants, 50.0% women, 92.4% Caucasian, were included. Median follow-up was 9 years (range 2–10): 4 years (range 1–8) before and 3 (range 1–9) after-T0. Mean age at the last study visit was 27.3 (±4.8) years, and mean CD4+ T-cells were 820.8 (±323.6) cells/mm3. Forty-five patients were switched to INSTI during the study, while 21 remained in the non-INSTI group. The INSTI group experienced a mean increase (pre-post T0) in bodyweight of 0.28 kg/year (95% CI − 0.29; 0.85, p = 0.338), while in the non-INSTI group, the mean increase was 0.36 kg/year (95% CI − 0.47; 1.20, p = 0.391), without a significant difference between groups (p for interaction between time and treatment regimen = 0.868). Among patients on INSTI, the weight gain after T0 was higher than pre-T0, amounting to +0.28 kg/year (95% CI − 0.29; 0.85), although this difference did not reach significance (p = 0.337). PHIV switched to an INSTI-based regimen did not experience an excessive weight gain compared to those who were treated with a non-INSTI based regimen in our cohort.
Collapse
|
42
|
Taramasso L, Bonfanti P, Ricci E, Orofino G, Squillace N, Menzaghi B, De Socio GV, Madeddu G, Pellicanò GF, Pagnucco L, Celesia BM, Calza L, Conti F, Martinelli CV, Valsecchi L, Cascio A, Bolla C, Maggi P, Vichi F, Dentone C, Angioni G, Mastroianni A, Falasca K, Cenderello G, Di Biagio A. Factors Associated With Weight Gain in People Treated With Dolutegravir. Open Forum Infect Dis 2020; 7:ofaa195. [PMID: 32577427 PMCID: PMC7295329 DOI: 10.1093/ofid/ofaa195] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background An unexpected excess in weight gain has recently been reported in the course of dolutegravir (DTG) treatment. The aim of the present study was to investigate whether weight gain differs among different DTG-containing regimens. Methods Adult naïve and experienced people with HIV (PWH) initiating DTG-based antiretroviral therapy (ART) between July 2014 and December 2019 in the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) prospective cohort were included. We used an adjusted general linear model to compare weight change among backbone groups and a Cox proportional hazard regression model to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for weight increases >10% from baseline. Results A total of 713 participants, 25.3% women and 91% Caucasian, were included. Of these, 195 (27.4%) started DTG as their first ART regimen, whereas 518 (72.6%) were ART-experienced. DTG was associated with abacavir/lamivudine in 326 participants, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 148, boosted protease inhibitors in 60, rilpivirine in 45, lamivudine in 75, and tenofovir alafenamide (TAF)/FTC in 59. At 6 and 12 months, weight gain was highest among PWH on TDF/FTC+DTG and TAF/FTC+DTG. Baseline CD4 <200 cells/mm3 (HR, 1.84; 95% CI, 1.15 to 2.96), being ART-naïve (HR, 2.24; 95% CI, 1.24 to 4.18), and treatment with TDF/FTC+DTG (HR, 1.92; 95% CI, 1.23 to 2.98) or TAF/FTC+DTG (HR, 3.80; 95% CI, 1.75 to 8.23) were associated with weight gain >10% from baseline. Higher weight (HR, 0.97 by 1 kg; 95% CI, 0.96 to 0.99) and female gender (HR, 0.54; 95% CI, 0.33 to 0.88) were protective against weight gain. Conclusions Naïve PWH with lower CD4 counts and those on TAF/FTC or TDF/FTC backbones were at higher risk of weight increase in the course of DTG-based ART.
Collapse
Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Bonfanti
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Elena Ricci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A," Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Giuseppe Vittorio De Socio
- Unit of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age "G. Barresi," Unit of Infectious Diseases, University of Messina, Messina, Italy
| | - Layla Pagnucco
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Benedetto Maurizio Celesia
- Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Federico Conti
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | | | - Laura Valsecchi
- Infectious Disease Unit (I Divisione), ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Cesare Bolla
- Infectious Diseases Unit, S.Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Dentone
- Infectious Disease Unit, Sanremo Hospital, Sanremo, Italy
| | | | - Antonio Mastroianni
- Unit of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d"Annunzio' Chieti-Pescara, Chieti, Italy
| | - Giovanni Cenderello
- Infectious Disease Unit, Sanremo Hospital, Sanremo, Italy.,Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| |
Collapse
|