Integrase Strand Transfer Inhibitors for Treatment-experienced Young Adults With Perinatal HIV in the US: Immunologic, Virologic, and Anthropometric Outcomes

Abstract

Background: The efficacy of integrase strand transfer inhibitors (INSTIs) among adults with HIV is well-established, though adverse effects, particularly weight gain, are common. Comparable data for treatment-experienced adolescents and young adults with perinatally-acquired HIV (AYAPHIV) are limited.

Methods: AYAPHIV in the US-based Pediatric HIV/AIDS Cohort Study who switched to bictegravir (BIC), dolutegravir (DTG), elvitegravir (EVG), or raltegravir (RAL) from any prior regimen were eligible. Using mixed-effects models, viral load, CD4 count, weight, and body mass index were described through 2 years after switch for each INSTI.

Results: Among 556 AYAPHIV, there were 167 switches to BIC, 282 to DTG, 189 to EVG, and 151 to RAL. Viral suppression (<200 copies/mL) at 1 and 2 years after switch was 74% and 69% for BIC, 62% and 60% for DTG, 76% and 68% for EVG, and 58% and 52% for RAL. Mean CD4 counts were above 500 cells/mm3 after switch through 2 years for all INSTIs. Average weight gain in the first year after switch to BIC, DTG, EVG, and RAL was 0.2, 2.5, 3.8, and -0.2 kilograms for females and 2.3, 4.8, 2.9, and 2.6 kilograms for males. Among previously underweight/healthy individuals, 13%, 18%, 36%, and 12% of females and 6%, 8%, 12%, and 11% of males switching to BIC, DTG, EVG, and RAL were overweight/obese by 2 years after switch.

Conclusions: Individual INSTI-based regimens among treatment-experienced AYAPHIV had moderate effectiveness with respect to viral suppression. Continued average weight gain across INSTIs raises concerns about long-term cardiometabolic sequalae.

Keywords: CD4 count; HIV viral load; integrase strand transfer inhibitors; perinatal HIV; weight gain.