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. 2025 Mar 17;80(3):575-584.
doi: 10.1093/cid/ciae474.

Short and Long-term Body Weight Change Following the Switch to or the Addition of Integrase Inhibitors in Persons With HIV Differs by Sex

Cecile D Lahiri  1 , C Christina Mehta  1 , Qian Yang  1 , Tsungirirai Maramba  1 , Joffi Musonge-Effoe  1 , Chin-An Yang  2 , Julie B Dumond  3 , Maria L Alcaide  4 , Jordan E Lake  5 , Leah H Rubin  6 , Audrey L French  7 , Jennifer Cocohoba  8 , Seble G Kassaye  9 , Anjali Sharma  10 , Frank J Palella  11 , John Mellors  12 , Deborah Konkle-Parker  13 , Elizabeth Topper  6 , Michael Augenbraun  14 , Mohammed K Ali  15   16 , Anandi N Sheth  1 , Thomas R Ziegler  17 , Igho Ofotokun  1 , Jessica A Alvarez  17
Affiliations

Short and Long-term Body Weight Change Following the Switch to or the Addition of Integrase Inhibitors in Persons With HIV Differs by Sex

Cecile D Lahiri et al. Clin Infect Dis. .

Abstract

Background: Sex-specific, long-term, body weight change in persons with human immunodeficiency virus (PWH) following switch to regimens containing integrase strand transfer inhibitors (INSTIs) is unknown.

Methods: We compared PWH enrolled in the MACS/WIHS Combined Cohort Study (2007-2020) who switched/added an INSTI to their antiretroviral therapy (ART) regimen to those remaining on non-INSTI ART and to people without human immunodeficiency virus (PWOH), by sex. Follow-up time was time since switch visit (or comparable visit in controls). Linear regression mixed-effects models assessed the effects of sex, group, and time upon weight and anthropometric measurements.

Results: Of 3464 participants included, women (411 INSTI, 709 non-INSTI, 818 PWOH) compared to men (223 INSTI, 412 non-INSTI, 891 PWOH) were younger (47.2 vs 54.5 years), were majority non-Hispanic Black (65% vs 23%), and had higher mean body mass index (31.5 vs 26.9 kg/m2), respectively. Women switching to INSTIs experienced greater absolute and percentage weight gain compared to men at 5 years: +3.0 kg (95% confidence interval [CI], 2.1-3.9) versus +1.8 kg (95% CI, .7-2.9) and +4.6% (95% CI, 3.5%-5.7%) versus +2.3% (95% CI, 1.0%-3.6%), respectively ([sex × time × group interaction, P < .01). Compared to men, women switching to INSTIs experienced greater hip and thigh circumference gain at 5 years: +2.6 cm (95% CI, 1.6-3.6) versus +1.2 cm (95% CI, .3-2.1) and +1.5 cm (95% CI, .7-2.2) versus -0.2 cm (95% CI, -.9 to .5), respectively.

Conclusions: Weight change among PWH over 5 years after switch to INSTI was 2-fold higher in women than men. The cardiometabolic implications of this difference in weight gain remain unknown.

Keywords: HIV; integrase inhibitors; sex differences; weight gain.

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Conflict of interest statement

Potential conflicts of interest . C. D. L. receives grant funding from NIH and Merck Pharmaceuticals and serves as an advisory board member and consultant for Theratechnologies, Inc. M. L. A. receives grant funding from NIH and AbbVie, serves on a Gilead advisory board, and has a fiduciary role with Discidium Biosciences. M. K. A. receives grant funding from NIH and serves on advisory boards for Bayer and Eli Lilly. J. E. L. receives grant funding from Gilead Sciences and serves as a consultant for Gilead Sciences and Theratechnologies. F. J. P. serves as a consultant and on the speakers bureau for ViiV, Gilead, and EMG/Serono. J. C. received grants from ViiV Healthcare, Janssen Pharmaceuticals, and Genentech; served as a symposium speaker for Clinical Care Options; served as a webinar speaker for the American Conference for the Treatment of HIV; and is a data and safety monitoring board (DSMB) member for the BFTAF Study. J. W. M. received grants from NIH, the US Agency for International Development, and Gilead Sciences; served as a consultant for Gilead Sciences; is a member of the CROI Foundation and President of the Foundation of Control of HIV Drug Resistance; and reports share options in Galapagos NV, Infectious Disease Connect, and MingMed Biotechnology. S. G. K. receives grants from NIH, developed HIV materials for Vindico Medical Education, and is a DSMB member for the WE RISE study. I. O. and L. H. R. received grants from NIH. All other authors report no conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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