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Review
. 2020 Feb;33(1):10-19.
doi: 10.1097/QCO.0000000000000616.

Weight gain and integrase inhibitors

Allison Ross Eckard  1 , Grace A McComsey  2
Affiliations
Review

Weight gain and integrase inhibitors

Allison Ross Eckard et al. Curr Opin Infect Dis. 2020 Feb.

Abstract

Purpose of review: Weight gain and obesity among people living with HIV (PLWH) is a serious problem that occurs often after initiation of antiretroviral therapy but may be worse with integrase strand transfer inhibitors (INSTIs). This article comprehensively reviews available data and summarizes our current understanding of the topic.

Recent findings: Recent studies support the concept that weight gain and treatment emergent obesity are worse with INSTI-based regimens, particularly dolutegravir. Women and nonwhites appear to be the most at risk, and the accompanying nucleoside reverse transcriptase inhibitor may play a role. Lipohypertrophy, an abnormal accumulation of visceral fat and/or ectopic fat depots, continues to be a problem among PLWH, but the role of INSTIs is inconsistent. The pathogenesis of weight gain and changes in body composition in HIV, especially with INSTIs, is poorly understood but may lead to serious comorbidities, such as cardiovascular disease and diabetes.

Summary: Although INSTI-based regimens are highly efficacious for viral suppression, they appear to cause more weight gain and treatment emergent obesity than non-INSTI-based regimens and may increase the risk of weight-related comorbidities. More studies are needed to understand the pathogenesis of weight gain with INSTIs in PLWH, in order to prevent this serious complication.

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Conflict of interest statement

Conflicts of Interest: GAM has served as a consultant for Theratechnologies, Gilead Sciences, Merck, and ViiV/GSK and received grant support to her institution from Bristol-Myers Squibb, Roche, Astellas, GlaxoSmithKline, and Gilead Sciences. ARE has served as an advisor and speaker for Theratechnologies and Gilead Sciences and has received grant support to her institution from Bristol-Myers Squibb, Cubist Pharmaceuticals, and GlaxoSmithKline.

References

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    1. Godfrey C, Bremer A, Alba D, et al. Obesity and fat metabolism in human immunodeficiency virus-infected individuals: Immunopathogenic mechanisms and clinical implications. J Infect Dis. 2019;220(3):420–31.

      ■ This review summarizes our current understanding of obesity and fat metabolism in people with HIV and highlights the need for aditional data.

    1. Koethe JR, Jenkins CA, Lau B, et al. Rising obesity prevalence and weight gain among adults starting antiretroviral therapy in the United States and Canada. AIDS Res Hum Retrovirses. 2016;32(1):50–8. - PMC - PubMed

    1. Sax PE, Erlandson KM, Lake JE, et al. Weight gain following initiation of antiretroviral therapy: Risk factors in randomized comparative clinical trials. Clin Infect Dis. 14 October 2019. Epub ahead of print.

      ■This study pools data from 8 phase 3, randomized-controlled trials to investigate weight gain after ART initiation.

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