Anne Marie Kerchberger1, Anandi N Sheth2, Christine D Angert3, C Christina Mehta3, Nathan A Summers2, Ighovwerha Ofotokun2, Deborah Gustafson4, Sheri D Weiser5, Anjali Sharma6, Adaora A Adimora7, Audrey L French8, Michael Augenbraun9, Jennifer Cocohoba10, Seble Kassaye11, Hector Bolivar12, Usha Govindarajulu13, Deborah Konkle-Parker14, Elizabeth T Golub15, Cecile D Lahiri2. 1. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. 2. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA. 3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA. 4. Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York, USA. 5. Department of Medicine, Division of Human Immunodeficiency Virus, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA. 6. Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA. 7. Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 8. Department of Medicine, Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, Illinois, USA. 9. Department of Medicine, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA. 10. Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA. 11. Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA. 12. Department of Medicine, Division of Infectious Diseases, University of Miami Health System, Miami, Florida, USA. 13. Department of Epidemiology and Biostatistics, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA. 14. Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center Jackson, Mississippi, USA. 15. Division of General Epidemiology and Methodology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended for human immunodeficiency virus (HIV) management. Although studies have suggested associations between INSTIs and weight gain, women living with HIV (WLHIV) have been underrepresented in research. We evaluated the effect of switching or adding INSTIs among WLHIV. METHODS: Women enrolled in the Women's Interagency HIV Study (WIHS) from 2006-2017 who switched to or added an INSTI to ART (SWAD group) were compared to women on non-INSTI ART (STAY group). Body weight, body mass index (BMI), percentage body fat (PBF), and waist, hip, arm, and thigh circumferences were measured 6-12 months before and 6-18 months after the INSTI switch/add in SWAD participants, with comparable measurement time points in STAY participants. Linear regression models compared changes over time by SWAD/STAY group, adjusted for age, race, WIHS site, education, income, smoking status, and baseline ART regimen. RESULTS: We followed 1118 women (234 SWAD and 884 STAY) for a mean of 2.0 years (+/- 0.1 standard deviation [SD]; mean age 48.8 years, SD +/- 8.8); 61% were Black. On average, compared to the STAY group, the SWAD group experienced mean greater increases of 2.1 kg in body weight, 0.8 kg/m2 in BMI, 1.4% in PBF, and 2.0, 1.9, 0.6, and 1.0 cm in waist, hip, arm, and thigh circumference, respectively (all P values < .05). No differences in magnitudes of these changes were observed by INSTI type. CONCLUSIONS: In WLHIV, a switch to INSTI was associated with significant increases in body weight, body circumferences, and fat percentages, compared to non-INSTI ART. The metabolic and other health effects of these changes deserve further investigation.
BACKGROUND: Integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended for human immunodeficiency virus (HIV) management. Although studies have suggested associations between INSTIs and weight gain, women living with HIV (WLHIV) have been underrepresented in research. We evaluated the effect of switching or adding INSTIs among WLHIV. METHODS: Women enrolled in the Women's Interagency HIV Study (WIHS) from 2006-2017 who switched to or added an INSTI to ART (SWAD group) were compared to women on non-INSTI ART (STAY group). Body weight, body mass index (BMI), percentage body fat (PBF), and waist, hip, arm, and thigh circumferences were measured 6-12 months before and 6-18 months after the INSTI switch/add in SWAD participants, with comparable measurement time points in STAY participants. Linear regression models compared changes over time by SWAD/STAY group, adjusted for age, race, WIHS site, education, income, smoking status, and baseline ART regimen. RESULTS: We followed 1118 women (234 SWAD and 884 STAY) for a mean of 2.0 years (+/- 0.1 standard deviation [SD]; mean age 48.8 years, SD +/- 8.8); 61% were Black. On average, compared to the STAY group, the SWAD group experienced mean greater increases of 2.1 kg in body weight, 0.8 kg/m2 in BMI, 1.4% in PBF, and 2.0, 1.9, 0.6, and 1.0 cm in waist, hip, arm, and thigh circumference, respectively (all P values < .05). No differences in magnitudes of these changes were observed by INSTI type. CONCLUSIONS: In WLHIV, a switch to INSTI was associated with significant increases in body weight, body circumferences, and fat percentages, compared to non-INSTI ART. The metabolic and other health effects of these changes deserve further investigation.
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