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. 2026 Feb 9;82(1):e78-e88.
doi: 10.1093/cid/ciaf538.

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

Kunjal Patel  1   2 , Alicia Jaramillo-Underwood  1 , Brad Karalius  1 , Tzy-Jyun Yao  2 , Russell B Van Dyke  3 , Ayesha Mirza  4 , Jennifer Jao  5 , Allison L Agwu  6   7 ; Pediatric HIV/AIDS Cohort Study (PHACS)
Collaborators, Affiliations

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

Kunjal Patel et al. Clin Infect Dis. .

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.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves for time to regimen discontinuation. Note: Censoring events are expressed as closed circles overlaid atop Kaplan-Meier curves.
Figure 2.
Figure 2.
Predicted HIV viral loads through 2 y after switch to INSTI-based regimen, by sex at birth.
Figure 3.
Figure 3.
Predicted mean CD4 count (cells/mm3) with confidence bands through 2 y after switch to INSTI-based regimen, by sex at birth.
Figure 4.
Figure 4.
Predicted mean weight (kg) with confidence bands through 2 y after switch to INSTI-based regimen, by sex at birth.
Figure 5.
Figure 5.
Predicted body mass index (BMI) through 2 y after switch to INSTI-based regimen, by sex at birth.
See this image and copyright information in PMC

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