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. 2022 Sep;54(3):419-432.
doi: 10.3947/ic.2022.0063. Epub 2022 Jul 12.

Weight Gain and Lipid Profile Changes in Koreans with Human Immunodeficiency Virus undergoing Integrase Strand Transfer Inhibitor-Based Regimens

Jin Kim  1 , Hyun-Ju Nam  1 , Yu-Jin Jung  2 , Hye-Jung Lee  2 , Seong-Eun Kim  1 , Seung-Ji Kang  1 , Kyung-Hwa Park  1 , Hyun-Ha Chang  2 , Shin-Woo Kim  2 , Eun-Kyung Chung  3 , Uh Jin Kim #  4 , Sook In Jung #  5
Affiliations

Weight Gain and Lipid Profile Changes in Koreans with Human Immunodeficiency Virus undergoing Integrase Strand Transfer Inhibitor-Based Regimens

Jin Kim et al. Infect Chemother. 2022 Sep.

Abstract

Background: This study explored the relationship between integrase strand transfer inhibitor (INSTI)-based anti-retroviral agents and weight gain over time, and the risk factors for weight gain in Korean people living with human immunodeficiency virus (PLWH).

Materials and methods: The study was conducted retrospectively in PLWHs 18 years of age or older who took one of three INSTI-based single-tablet regimens (STRs) (tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat [TDF/F/EVG/c], tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat [TAF/F/EVG/c], and abacavir/lamivudine/dolutegravir [ABC/3TC/DTG]) for more than 2 years at three university-affiliated hospitals in South Korea from May 2014 to December 2020. Analysis was performed in the treatment-naïve and treatment-experienced groups, respectively.

Results: Individual INSTI-based STRs were associated with weight gain at the 24-month follow up in both treatment-naïve (n = 179) and treatment-experienced (n = 290) groups. Body mass index (BMI) categories changed over time for TAF/F/EVG/c and ABC/3TC/DTG, with significant increases in the rates of overweight and obesity in treatment-naïve patients, whereas there was no change for TDF/F/EVG/c. TAF/F/EVG/c significantly increased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) compared to other regimens over 24 months. In the treatment-naïve group, a baseline CD4+ T cell count <100 cells/mm3, human immunodeficiency virus (HIV) viral load (VL) ≥100,000 copies/mL, no physical exercise, and TAF/F/EVG/c (vs. TDF/F/EVF/c) were risk factors for ≥10% weight gain. In the treatment-experienced group, age <45 years, BMI <25 kg/m², and no physical exercise were risk factors for ≥5% weight gain.

Conclusion: INSTI-based STR continued to increase body weight at the 24-month follow up in treated and untreated Korean PLWH. Exercise, together with demographic-, HIV-, and anti-retroviral therapy-related factors, influenced weight gain. Therefore, when prescribing an INSTI-based STR, weight gain and metabolic changes should be closely monitored in PLWH with these risk factors.

Keywords: Anti-retroviral agents; Human immunodeficiency virus; Integrase inhibitor; Lipid; Weight gain.

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Conflict of interest statement

SIJ is an associate editor of Infection & Chemotherapy; however, she was not involved in the peer reviewer selection, evaluation, or decision-making for this article. Otherwise, no potential conflicts of interest relevant to this article are reported.

Figures

Figure 1
Figure 1. Changes in body weight, weight gain rate, body mass index (BMI), and BMI category distribution within 24 months after initiation of treatment with three fixed-dose combination drugs based on integrase strand transfer inhibitors compared to baseline in treatment-naïve patients. (A) Mean weight change, (B) mean weight gain rate, (C) mean BMI change, and (D) BMI category distribution.
TAF/F/EVG/c, tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat; ABC/3TC/DTG, abacavir/lamivudine/dolutegravir; TDF/F/EVG/c, tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat; ART, antiretroviral therapy.
Figure 2
Figure 2. Changes in body weight, weight gain rate body mass index (BMI), and BMI category distribution over 24 months of treatment with three fixed-dose regimens based on integrase strand transfer inhibitors compared to baseline in treatment-experienced patients. (A) Mean weight change, (B) mean weight gain rate, (C) mean BMI change, and (D) BMI category distribution.
TAF/F/EVG/c, tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat; ABC/3TC/DTG, abacavir/lamivudine/dolutegravir; TDF/F/EVG/c, tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat; ART, antiretroviral therapy.
Figure 3
Figure 3. Changes in lipid profile over 24 months of treatment with three integrase strand transfer inhibitor-based fixed-dose regimens compared to baseline.
aStatistically significant difference (P <0.05). HDL, high-density lipoprotein; mo, month; LDL, low-density lipoprotein; TDF/F/EVG/c, tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat; TAF/F/EVG/c, tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat; ABC/3TC/DTG, abacavir/lamivudine/dolutegravir.
Figure 4
Figure 4. Risk factors for weight gain in treatment-naïve and treatment-experienced individuals treated with integrase strand transfer inhibitors.
aStatistically significant difference (P <0.05). BMI, body mass index, VL, viral load; TAF/F/EVG/c, tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat; TDF/F/EVG/c, tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat; ABC/3TC/DTG, abacavir/lamivudine/dolutegravir; OR, odd ratio; CI, confidence interval.
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