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Kityo C, Mambule IK, Musaazi J, Sokhela S, Mugerwa H, Ategeka G, Cresswell F, Siika A, Kosgei J, Shah R, Naidoo L, Opiyo K, Otike C, Möller K, Kaimal A, Wambui C, Van Eygen V, Mohammed P, Addo Boateng F, Paton NI. Switch to long-acting cabotegravir and rilpivirine in virologically suppressed adults with HIV in Africa (CARES): week 48 results from a randomised, multicentre, open-label, non-inferiority trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:1083-1092. [PMID: 38821073 DOI: 10.1016/s1473-3099(24)00289-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Long-acting injectable cabotegravir and rilpivirine is licensed for individualised treatment of HIV-1 infection in resource-rich settings. Additional evidence is required to support use in African treatment programmes where demographic factors, viral subtypes, previous treatment, and delivery and monitoring approaches differ. The aim of this study was to determine whether switching to long-acting therapy with injections every 8 weeks is non-inferior to daily oral therapy in Africa. METHODS CARES is a randomised, open-label, non-inferiority trial being conducted at eight sites in Uganda, Kenya, and South Africa. Participants with HIV viral load below 50 copies per mL on oral antiretroviral therapy and no history of virological failure were randomly assigned (1:1; web-based, permuted blocks) to receive cabotegravir (600 mg) and rilpivirine (900 mg) by intramuscular injection every 8 weeks, or to continue oral therapy. Viral load was monitored every 24 weeks. The primary outcome was week 48 viral load below 50 copies per mL, assessed with the Food and Drug Administration snapshot algorithm (non-inferiority margin 10 percentage points) in the intention-to-treat exposed population. This trial is registered with the Pan African Clinical Trials Registry (202104874490818) and is ongoing up to 96 weeks. FINDINGS Between Sept 1, 2021, and Aug 31, 2022, we enrolled 512 participants (295 [58%] female; 380 [74%] previous non-nucleoside reverse transcriptase inhibitor exposure). Week 48 viral load was below 50 copies per mL in 246 (96%) of 255 participants in the long-acting therapy group and 250 (97%) of 257 in the oral therapy group (difference -0·8 percentage points; 95% CI -3·7 to 2·3), demonstrating non-inferiority (confirmed in per-protocol analysis). Two participants had virological failure in the long-acting therapy group, both with drug resistance; none had virological failure in the oral therapy group. Adverse events of grade 3 or greater severity occurred in 24 (9%) participants on long-acting therapy and ten (4%) on oral therapy; one participant discontinued long-acting therapy (for injection-site reaction). INTERPRETATION Long-acting therapy had non-inferior efficacy compared with oral therapy, with a good safety profile, and can be considered for African treatment programmes. FUNDING Janssen.
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Affiliation(s)
- Cissy Kityo
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | | | | | - Simiso Sokhela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Henry Mugerwa
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | | | - Fiona Cresswell
- Infectious Diseases Institute, Kampala, Uganda; London School of Hygiene & Tropical Medicine, London, UK; Centre for Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Abraham Siika
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Josphat Kosgei
- Kenya Medical Research Institute/US Army Medical Research Directorate, Africa (Kenya), Kericho, Kenya
| | - Reena Shah
- Aga Khan University Hospital, Nairobi, Kenya
| | - Logashvari Naidoo
- Chatsworth Clinical Research Site, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Kimton Opiyo
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | | | - Karlien Möller
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Charity Wambui
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | | | - Perry Mohammed
- Johnson & Johnson, High Wycombe, UK; ViiV Healthcare, Brentford, UK
| | | | - Nicholas I Paton
- London School of Hygiene & Tropical Medicine, London, UK; Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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2
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Russo SC, Ockene MW, Arpante AK, Johnson JE, Lee H, Toribio M, Stanley TL, Hadigan CM, Grinspoon SK, Erlandson KM, Fourman LT. Efficacy and safety of tesamorelin in people with HIV on integrase inhibitors. AIDS 2024; 38:1758-1764. [PMID: 38905488 PMCID: PMC11365754 DOI: 10.1097/qad.0000000000003965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Tesamorelin is the only FDA-approved therapy to treat abdominal fat accumulation in people with HIV (PWH). Phase III clinical trials were conducted prior to the introduction of integrase inhibitors (INSTIs), which are now a mainstay of HIV antiretroviral therapy. DESIGN We leveraged a randomized double-blind trial of 61 PWH and metabolic dysfunction-associated steatotic liver disease to evaluate the efficacy and safety of tesamorelin 2 mg once daily vs. identical placebo among participants on INSTI-based regimens at baseline. METHODS In the parent clinical trial, visceral fat cross-sectional area, hepatic fat fraction, and trunk-to-appendicular fat ratio were quantified using magnetic resonance imaging, proton magnetic resonance spectroscopy, and dual-energy x-ray absorptiometry, respectively, at baseline and 12 months. Metabolic and safety outcomes were compared between treatment arms. RESULTS Among 38 participants on INSTI-based regimens at baseline, 15 individuals on tesamorelin and 16 individuals on placebo completed the 12-month study. Tesamorelin led to significant declines in visceral fat (median [interquartile range]: -25 [-93, -2] vs. 14 [3, 41] cm 2 , P = 0.001), hepatic fat (-4.2% [-12.3%, -2.7%] vs. -0.5% [-3.9%, 2.7%], P = 0.01), and trunk-to-appendicular fat ratio (-0.1 [-0.3, 0.0] vs. 0.0 [-0.1, 0.1], P = 0.03). Tesamorelin was well tolerated with a similar frequency of adverse events, including hyperglycemia, between groups. CONCLUSIONS The current analysis provides the first dedicated data on the efficacy and safety of tesamorelin among PWH on INSTI-based regimens. Despite the association of INSTI use with weight gain and adipose tissue dysfunction, tesamorelin had beneficial effects on body composition with no exacerbation of glycemic control.
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Affiliation(s)
- Samuel C Russo
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Mollie W Ockene
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Allison K Arpante
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Julia E Johnson
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Hang Lee
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Mabel Toribio
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Takara L Stanley
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Colleen M Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
| | - Kristine M Erlandson
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School
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3
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Manne-Goehler J, Siedner MJ. Untangling the causal ties between antiretrovirals and obesity. Lancet HIV 2024; 11:e650-e651. [PMID: 39186941 DOI: 10.1016/s2352-3018(24)00214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Jennifer Manne-Goehler
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Infectious Diseases and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mark J Siedner
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Infectious Diseases and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Africa Health Research Institute, KwaZulu-Natal, South Africa; University of KwaZulu-Natal, Durban, South Africa.
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4
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Drechsler H, Ayers C, Oboho I, Enwerem N, Hanna J, Clark C, Kitchell E, Jain M, Luque A, Bedimo R. Choice of antiretroviral therapy has low impact on weight gain. AIDS 2024; 38:1731-1739. [PMID: 38831733 DOI: 10.1097/qad.0000000000003950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Antiretroviral therapy (ART) containing integrase inhibitors (INSTIs) and/or tenofovir alafenamide (TAF) has been associated with greater weight gain. Yet few studies have delineated between exposure to 'anchor' drugs [protease inhibitors (PI), nonnucleoside reverse transcriptase inhibitors (NNRTI) or INSTIs] and exposure to nucleoside reverse transcriptase inhibitors (NRTIs). DESIGN In this cohort of antiretroviral drug-naive patients who initiated ART from 2008-2022, we analyzed BMI gain for eight contemporary 'anchor' drugs and three contemporary NRTIs during the first 3 years of ART. We censored patients if they stopped, switched, or added another antiretroviral drug to their regimen. METHODS We used generalized estimating equations (GEE) to assess the association between BMI gain and choice of ART and a nonlinear mixed model for the marginal coefficients of determination. We adjusted for time, baseline demographic and HIV-characteristics, and time-updated HIV and substance use-related variables. RESULTS The median BMI gain in 4 194 patients over 3 years was + 1.9 kg/m 2 [interquartile range (IQR) 0.1-4.1]. Most patients were black (55%) and men (77%). Multivariable modeling from 20 528 BMI measurements revealed that the type of ART accounted for just 9% of the predicted BMI change. Only efavirenz (EFV) and tenofovir disoproxil fumarate (TDF) were independently associated with (lower) weight gain but no differences were observed between INSTIs, PIs, and rilpivirine, or between TAF and abacavir. CONCLUSION The choice of initial ART had little impact on weight gain. INSTIs or TAF were not independently associated with weight change after ART initiation, but EFV and TDF were.
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Affiliation(s)
- Henning Drechsler
- Department of Medicine, University of Texas Southwestern
- Veterans Affairs North Texas Healthcare System, Medical Service, Dallas, TX
| | - Colby Ayers
- Department of Medicine, University of Texas Southwestern
| | - Ikwo Oboho
- Department of Medicine, University of Texas Southwestern
- Veterans Affairs North Texas Healthcare System, Medical Service, Dallas, TX
| | - Ngozi Enwerem
- Department of Medicine, University of Texas Southwestern
- Veterans Affairs North Texas Healthcare System, Medical Service, Dallas, TX
| | - John Hanna
- Department of Medicine, University of Texas Southwestern
- ECU Health, Information Services, Greenville, NC
| | | | - Ellen Kitchell
- Department of Medicine, University of Texas Southwestern
- Parkland Memorial Hospital, Dallas, TX, USA
| | - Mamta Jain
- Department of Medicine, University of Texas Southwestern
- Parkland Memorial Hospital, Dallas, TX, USA
| | - Amneris Luque
- Department of Medicine, University of Texas Southwestern
- Parkland Memorial Hospital, Dallas, TX, USA
| | - Roger Bedimo
- Department of Medicine, University of Texas Southwestern
- Veterans Affairs North Texas Healthcare System, Medical Service, Dallas, TX
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Woods J, Sokhela S, Akpomiemie G, Bosch B, Möller K, Bhaskar E, Kruger C, Manentsa N, Tom N, Macholo P, Chandiwana N, Hill A, Moorhouse M, Venter WDF. DORA: 48-week weight and metabolic changes in Black women with HIV, in a phase IIIb switch study from dolutegravir- or efavirenz- to doravirine-based first-line antiretroviral therapy. HIV Med 2024. [PMID: 39286902 DOI: 10.1111/hiv.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/31/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVES Treatment-related weight gain and metabolic complications with antiretroviral integrase-based regimens, especially among Black women, suggest the need for alternative options. METHODS We conducted a 48-week, open-label, single-arm, single-centre, phase IIIb switch study to evaluate the tolerability, safety and efficacy of switching from stable efavirenz- or dolutegravir-based antiretroviral therapy to doravirine/lamivudine/tenofovir disoproxil fumarate in Black women. RESULTS The 101 participants enrolled (median age 35 years; interquartile range 31-40) were on efavirenz (n = 46; mean duration on therapy 1.7 years) or dolutegravir-based (n = 55; mean duration 1.5 years) antiretrovirals at screening. Retention at 48 weeks was 92/101 participants, and viral suppression was >90% throughout the study, with a single case of doravirine resistance (106 M, V108I and H221Y mutations). The mean weight percentage change at week 48 was 4.7% (95% confidence interval [CI] 3.0-6.5; p < 0.001), and the adjusted mean change was 2.7 kg (95% CI 1.50-3.98; p < 0.001); for efavirenz, the percentage change was 5.0% (95% CI 2.9-7.1; p < 0.001), and the adjusted weight gain was 3.5 kg (95% CI 1.93-5.13); for dolutegravir, the percentage change was 4.5% (95% CI 1.8-7.3; p < 0.001), and the adjusted weight gain was 2.1 kg (95% CI 0.26-3.90). Statistically significant decreases in lipid panel percent mean to week 48 included: total cholesterol -8.4% (95% CI -11.3 to -5.5; p < 0.001), triglycerides -10.4% (95% CI -16.4 to -4.4; p < 0.001) and high-density lipoprotein -14.8% (95% CI -18.5 to -11.2%; p < 0.001), with minor differences when disaggregating the mean percent change in lipids between previous efavirenz/dolutegravir regimens. Adverse events due to doravirine were few and mild. CONCLUSIONS Our findings suggest that a switch to doravirine from efavirenz or dolutegravir is safe and effective in Black women, with significant improvement in lipid profiles, but does not arrest progressive weight gain.
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Affiliation(s)
- Joana Woods
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simiso Sokhela
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Godspower Akpomiemie
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Bosch
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karlien Möller
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Esther Bhaskar
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chelsea Kruger
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ncomeka Manentsa
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Noxolo Tom
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philadelphia Macholo
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba Chandiwana
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Michelle Moorhouse
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health Medicine, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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6
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Bailin SS, Koethe JR. Weight Gain and Antiretroviral Therapy. Infect Dis Clin North Am 2024; 38:499-515. [PMID: 38871568 PMCID: PMC11305935 DOI: 10.1016/j.idc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Antiretroviral therapy (ART) agents as a determinant of body weight in ART-naïve and ART-experienced persons with human immunodeficiency virus (HIV) (PWH) has become a major focus area in research and clinical settings. Recent studies demonstrating weight-suppressing properties of efavirenz and tenofovir disoproxil fumarate led to re-evaluation of weight gain studies, and a reassessment of whether other agents are weight promoting versus weight neutral. In this review, the authors synthesize recent literature on factors related to obesity, clinical measurements of adiposity, weight gain in ART-naïve and ART-experienced PWH, metabolic consequences of ART and weight gain, and the clinical management of weight gain in PWH.
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Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 Medical Center North, Nashville, TN 37232, USA.
| | - John R Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 Medical Center North, Nashville, TN 37232, USA
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7
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Savinelli S, Newman E, Mallon PWG. Metabolic Complications Associated with Use of Integrase Strand Transfer Inhibitors (InSTI) for the Treatment of HIV-1 Infection: Focus on Weight Changes, Lipids, Glucose and Bone Metabolism. Curr HIV/AIDS Rep 2024:10.1007/s11904-024-00708-x. [PMID: 39207722 DOI: 10.1007/s11904-024-00708-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize recently published peer reviewed papers on the influence of treatment with Integrase Strand Transfer Inhibitors (InSTI) in people with HIV (HIV) on metabolic health, including weight gain, lipid parameters, glucose homeostasis, and bone health. RECENT FINDINGS InSTI have a mild/moderate effect on weight gain in both antiretroviral (ART) naïve and ART experienced PWH, which is more pronounced in certain groups (i.e. women, people of Black African ethnicity, those with lower socioeconomic status, and older people). The effect on weight is also driven by other components of the ART regimen as well as previous exposure to certain ART. InSTI have a relatively safe profile in terms of lipid parameters and bone health, compared to other ART classes, although some studies suggest a greater risk of insulin resistance and diabetes in PWH using InSTI, especially 2nd generation InSTI. While there is some evidence suggesting a negative impact of InSTI on some aspects of metabolic health (weight gain and glucose homeostasis), they remain the preferred treatment option for most PWH, due to their high efficacy and tolerability. However, an individualised approach to ART choice in PWH should be used in order to avoid negative outcomes in populations at higher risks of metabolic complications.
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Affiliation(s)
- Stefano Savinelli
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin (UCD) School of Medicine, Dublin, Ireland.
| | - Ellen Newman
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Patrick W G Mallon
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin (UCD) School of Medicine, Dublin, Ireland
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Pedersen KBH, Gelpi M, Knudsen AD, Meddis A, Suarez-Zdunek MA, Afzal S, Nordestgaard B, Nielsen SD, Benfield T. Nucleoside/nucleotide reverse transcriptase inhibitor-associated weight gain in people living with HIV: data from the Copenhagen Comorbidity in HIV Infection (COCOMO) study. AIDS Care 2024:1-12. [PMID: 39164663 DOI: 10.1080/09540121.2024.2383871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/18/2024] [Indexed: 08/22/2024]
Abstract
Weight gain effects of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors in people with HIV (PWH) have been sparsely studied.Participants were enrolled in the Copenhagen Comorbidity in HIV Infection (COCOMO) study. PWH receiving a backbone of emtricitabine, or lamivudine combined with abacavir, tenofovir disoproxil, or tenofovir alafenamide were analysed. Weight gain according to ART backbone and to the third drug was analysed using a multiple linear regression model. Non-ART risk factors were also determined using multiple linear regression.A total of 591 participants were included in the analysis. The majority were middle-aged, virally suppressed males with a mean BMI just above the normal range. Both tenofovir disoproxil/emtricitabine or lamivudine and abacavir /emtricitabine or lamivudine, but not tenofovir alafenamide /emtricitabine or lamivudine were associated with weight gain over two years (0.6 kg, p = 0.025; 1.0 kg, p = 0.005). The third drugs associated with weight increase were non-nucleoside reverse transcriptase inhibitors (NNRTI) (p = 0.035), dolutegravir (p = 0.008) and atazanavir (p = 0.040). Non-ART risk factors for gaining weight were low or normal BMI, age <40 years, underweight, inactivity or highly active at baseline.Tenofovir disoproxil and abacavir-based ART regimens were associated with a small weight gain. Third drug NNRTI, dolutegravir and atazanavir were associated with an increase in weight.
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Affiliation(s)
- Karen Brorup Heje Pedersen
- Departments of Infectious diseases, Copenhagen University Hospital - Amager and Hvidovre, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Denmark
| | | | - Alessandra Meddis
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Shoaib Afzal
- Department of Clinical Biochemistry, and The Copenhagen General Population Study, Copenhagen University Hospital Herlev and Gentofte Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Børge Nordestgaard
- Department of Clinical Biochemistry, and The Copenhagen General Population Study, Copenhagen University Hospital Herlev and Gentofte Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Benfield
- Departments of Infectious diseases, Copenhagen University Hospital - Amager and Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Bar Ziv O, Cahn A, Jansen T, Istomin V, Kedem E, Olshtain-Pops K, Israel S, Oster Y, Orenbuch-Harroch E, Korem M, Strahilevitz J, Levy I, Valdés-Mas R, Ivanova V, Elinav E, Shahar E, Elinav H. Diagnosis and Risk Factors of Prediabetes and Diabetes in People Living With Human Immunodeficiency Virus: Evaluation of Clinical and Microbiome Parameters. J Infect Dis 2024; 230:411-420. [PMID: 38557867 DOI: 10.1093/infdis/jiae167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 03/08/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Diabetes mellitus (DM) is more common among people living with human immunodeficiency virus (PLWH) compared with healthy individuals. In a prospective multicenter study (N = 248), we identified normoglycemic (48.7%), prediabetic (44.4%), and diabetic (6.9%) PLWH. Glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) sensitivity in defining dysglycemia was 96.8%, while addition of oral glucose tolerance test led to reclassification of only 4 patients. Inclusion of 93 additional PLWH with known DM enabled identification of multiple independent predictors of dysglycemia or diabetes: older age, higher body mass index, Ethiopian origin, HIV duration, lower integrase inhibitor exposure, and advanced disease at diagnosis. Shotgun metagenomic microbiome analysis revealed 4 species that were significantly expanded with hyperglycemia/hyperinsulinemia, and 2 species that were differentially more prevalent in prediabetic/diabetic PLWH. Collectively, we uncover multiple potential host and microbiome predictors of altered glycemic status in PLWH, while demonstrating that FBG and HbA1c likely suffice for diabetes screening. These potential diabetic predictors merit future prospective validation.
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Affiliation(s)
- Omer Bar Ziv
- Department of Military Medicine and "Zameret," Faculty of Medicine, Hebrew University, and Israel and Medical Corps, Israel Defense Forces
| | - Avivit Cahn
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center
- Faculty of Medicine, Hebrew University, Jerusalem
| | - Tallulah Jansen
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot
| | | | - Eynat Kedem
- Allergy, Immunology and AIDS Unit, Rambam Medical Center, Haifa
| | - Karen Olshtain-Pops
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
| | - Sarah Israel
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
| | - Efrat Orenbuch-Harroch
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
| | - Maya Korem
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
| | - Jacob Strahilevitz
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
| | - Itzchak Levy
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Rafael Valdés-Mas
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot
| | - Valeria Ivanova
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot
| | - Eran Elinav
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot
- Division of Microbiome and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Eduardo Shahar
- Allergy, Immunology and AIDS Unit, Rambam Medical Center, Haifa
| | - Hila Elinav
- Faculty of Medicine, Hebrew University, Jerusalem
- Hadassah AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem
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Zhang F, Wu H, Cai W, Ma P, Zhao Q, Wei H, Lu H, Wang H, He S, Chen Z, Chen Y, Wang M, Wan W, Fu H, Qin H. Switch to fixed-dose ainuovirine, lamivudine, and tenofovir DF versus elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in virologically suppressed people living with HIV-1: the 48-week results of the SPRINT trial, a multi-centre, randomised, double-blind, active-controlled, phase 3, non-inferiority trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 49:101143. [PMID: 39092318 PMCID: PMC11293588 DOI: 10.1016/j.lanwpc.2024.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/14/2024] [Accepted: 06/28/2024] [Indexed: 08/04/2024]
Abstract
Background We compared the efficacy and safety profiles of ainuovirine (ANV), a new-generation non-nucleoside reverse transcriptase inhibitor (NNRTI), with boosted elvitegravir (EVG), both coformulated with two nucleoside reverse transcriptase inhibitors (NRTIs), in people living with HIV-1 (PLWH) who had achieved virological suppression on previous NNRTI-based antiretroviral (ARV) regimen. Methods This study was a multi-centre, randomised, double-blind, active-controlled, non-inferiority trial recruiting PLWH from 10 clinical centres across China. Main inclusion criteria included age of 18-65 years (inclusive), and stably staying on an ARV regimen combining an NNRTI with a two-drug NRTI backbone for at least 12 months. Eligible participants must have maintained plasma HIV-1 ribonucleic acid (RNA) titre below 50 copies per mL confirmed on two successive tests at an interval of at least one month prior to randomisation. Participants were randomly assigned to receive ANV 150 mg plus lamivudine (3TC) 300 mg, and tenofovir disoproxil fumarate (TDF) 300 mg (ANV/3TC/TDF), or cobicistat (Cobi) 150 mg boosted EVG plus emtricitabine (FTC) 200 mg, and tenofovir alafenamide (TAF) 10 mg. The primary efficacy endpoint was the proportion of participants with HIV-1 RNA titre at 50 copies per mL or above at week 48 using the US Food and Drug Administration snapshot algorithm, with a non-inferiority margin of 4 percentage points at a two-side 95% confidence level. This trial is active, but not recruiting, and is registered with Chinese Clinical Trial Registry (ChiCTR), number ChiCTR2100051605. Findings Between October 2021 and February 2022, 923 patients were screened for eligibility, among whom 762 participants were randomized and had received at least one dose of ANV/3TC/TDF (n = 381) or EVG/Cobi/FTC/TAF (n = 381). At week 48, 7 (1.8%) participants on ANV/3TC/TDF and 6 (1.6%) participants on EVG/Cobi/FTC/TAF had plasma HIV-1 RNA titre at 50 copies per mL or above, including missing virological data within the time window (the Cochran-Mantel-Haenszel method, estimated treatment difference [ETD], 0.3%, 95% CI -1.6 to 2.1), establishing the non-inferiority of ANV/3TC/TDF to EVG/Cobi/FTC/TAF. The proportions of participants experiencing at least one treatment-emergent adverse events (AEs) were comparable between the two arms (97.6% versus 97.6%). A small proportion of participants discontinued study drug due to AEs (0.3% versus 0.3%). Serious AEs occurred in 11 (2.9%) participants on ANV/3TC/TDF and 9 (2.4%) participants on EVG/Cobi/FTC/TAF, respectively, none of which was considered related to study drug at the jurisdiction of the investigator. At week 48, participants on ANV/3TC/TDF showed a significantly less weight gain from baseline compared to those on EVG/Cobi/FTC/TAF (least square mean, 1.16 versus 2.05 kg, ETD -0.90 kg, 95% CI, -1.43 to -0.37). The changes in serum lipids from baseline also favoured ANV/3TC/TDF over EVG/Cobi/FTC/TAF. Interpretation In virologically suppressed PLWH on previous NNRTI-based ARV regimen, switch to ANV/3TC/TDF resulted in less weight gain, and improved lipid metabolism while maintaining virological suppression non-inferior to that to EVG/Cobi/FTC/TAF. Funding Jiangsu Aidea Pharmaceutical & the National "Thirteenth Five-year Period" Major Innovative Drugs Research and Development Key Project of the People's Republic of China Ministry of Science and Technology.
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Affiliation(s)
- Fujie Zhang
- Beijing Ditan Hospital Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Hao Wu
- Beijing Youan Hospital, Capital Medical University, No. 8, West Toutiao, You'anmenwai, Fengtai District, Beijing, 100069, China
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, No. 8, Huaying Road, Jiahe Street, Baiyun District, Guangzhou, 510145, Guangdong Province, China
| | - Ping Ma
- Tianjin Second People's Hospital, No. 7, Sudi South Road, Nankai District, Tianjin, 300141, China
| | - Qingxia Zhao
- The Sixth People's Hospital of Zhengzhou, No. 29, Jingguang South Road, Erqi District, Zhengzhou, 450015, Henan Province, China
| | - Hongxia Wei
- The Second Hospital of Nanjing, No. 1-1, Zhongfu Road, Gulou District, Nanjing, 210003, Jiangsu Province, China
| | - Hongzhou Lu
- Shenzhen Third People's Hospital, No. 29, Bulan Road, Longgang District, Shenzhen, 518112, Guangdong Province, China
| | - Hui Wang
- Shenzhen Third People's Hospital, No. 29, Bulan Road, Longgang District, Shenzhen, 518112, Guangdong Province, China
| | - Shenghua He
- Public Health Clinical Medical Center of Chengdu, No. 377, Jingming Road, Jinjiang District, Chengdu, 610066, Sichuan Province, China
| | - Zhu Chen
- Public Health Clinical Medical Center of Chengdu, No. 377, Jingming Road, Jinjiang District, Chengdu, 610066, Sichuan Province, China
| | - Yaokai Chen
- Chongqing Public Health Medical Center, No. 109, Geyue Mountain Conservation Road, Shapingba District, Chongqing, 400030, China
| | - Min Wang
- Changsha First Hospital, No. 311, Yingpan Road, Kaifu District, Changsha, 410005, Hunan Province, China
| | - Wan Wan
- Jiangsu Aidea Pharmaceutical Co., Ltd, No. 69, New Ganquan West Road, Hanjiang District, Yangzhou, 225008, Jiangsu Province, China
| | - Heliang Fu
- Jiangsu Aidea Pharmaceutical Co., Ltd, No. 69, New Ganquan West Road, Hanjiang District, Yangzhou, 225008, Jiangsu Province, China
| | - Hong Qin
- Jiangsu Aidea Pharmaceutical Co., Ltd, No. 69, New Ganquan West Road, Hanjiang District, Yangzhou, 225008, Jiangsu Province, China
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Mogasala S, Helzer C, Welch RD, Secord E, McGrath E. Impact of the COVID-19 pandemic on BMI in youth living with HIV. SAGE Open Med 2024; 12:20503121241267081. [PMID: 39081660 PMCID: PMC11287722 DOI: 10.1177/20503121241267081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/19/2024] [Indexed: 08/02/2024] Open
Abstract
Background Many youth saw a rise in body mass index and obesity during the COVID-19 pandemic associated with virtual schooling and a lack of physical exercise options due to lockdown orders. However, the impact of the worldwide COVID-19 pandemic on body mass index in HIV-infected youth on anti-viral therapy has not been studied. Objective This study examined COVID-19's impact on body mass index in 157 behaviorally acquired and 39 perinatally acquired youth living with HIV. Methods Retrospective chart analysis was conducted for body mass index records across pre-COVID, COVID, and post-COVID periods. Results Age and acquired type showed significant associations with increased body mass index. Limitations included missing data and physiological body mass index changes. Conclusion The perinatally acquired group's body mass index increased by 1.6 during and 2.3 post-pandemic compared to pre-pandemic levels. Longitudinal follow-up of body mass index changes is needed in this vulnerable population.
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Affiliation(s)
- Saiteja Mogasala
- Medical Education, Wayne State University School of Medicine, Detroit, MI, USA
| | - Catherine Helzer
- Medical Education, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert D Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Biostatistics and Epidemiology Research Design, Integrated Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eric McGrath
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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12
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Migisha R, Chen G, Muyindike WR, Aung TN, Nanfuka V, Komukama N, Chandiwana N, Shazi G, Tien D, Moosa MYS, Gupta RK, Pillay D, Marconi VC, Hedt-Gauthier B, Venter WD, Siedner MJ, McCluskey SM, Manne-Goehler J. Regional variation in weight change after the transition to dolutegravir in Uganda and South Africa. AIDS 2024; 38:1314-1322. [PMID: 38507584 PMCID: PMC11211050 DOI: 10.1097/qad.0000000000003888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND People with HIV (PWH) on integrase inhibitor-based regimens may be at risk of excess weight gain, but it is unclear if this risk is consistent across settings. We assessed weight change over 48 weeks among PWH who were transitioned to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD). DESIGN We conducted a prospective cohort study at public-sector HIV clinics in Uganda and South Africa. METHODS Eligible participants were adults who were transitioned to TLD. Weight was measured at enrollment, 24-, and 48-weeks post TLD transition. Our outcomes were weight change, change in waist circumference, and clinically significant weight gain, defined as ≥10% increase in weight from baseline, over 48 weeks. We used linear mixed-effects regression models, adjusted for demographic factors, to estimate weight gain and identify risk factors. RESULTS Weight data were available for 428 participants in Uganda and 367 in South Africa. The mean weight change was 0.6 kg [95% CI: 0.1-1.0] in Uganda and 2.9 kg [2.3-3.4] in South Africa ( P < 0.001). The mean change in waist circumference was 0.8 cm [95% CI: 0.0-1.5]) in Uganda and 2.3 cm [95% CI: 1.4-3.2] in South Africa ( P = 0.012). Clinically significant weight gain occurred in 9.8% [7.0-12.6] of participants in Uganda and 18.0% [14.1-21.9] in South Africa ( P < 0.001). After adjustment, PWH gained significantly less weight in Uganda than in South Africa. CONCLUSIONS PWH in South Africa experienced significantly greater weight gain and increases in waist circumference compared to Uganda. Strategies to address weight gain in PWH should be carefully considered and may vary by region.
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Affiliation(s)
- Richard Migisha
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Geoffrey Chen
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Taing Nandi Aung
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Nomathemba Chandiwana
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Dessie Tien
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ravindra K. Gupta
- Africa Health Research Institute, Durban, South Africa
- University of Cambridge, Cambridge, United Kingdom
| | | | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Willem D.F. Venter
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark J. Siedner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Africa Health Research Institute, Durban, South Africa
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne M. McCluskey
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Manne-Goehler
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA
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Fernández A, Imaz A. Clinical considerations when switching antiretroviral therapy. Expert Rev Clin Pharmacol 2024; 17:565-577. [PMID: 38850057 DOI: 10.1080/17512433.2024.2365826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Antiretroviral therapy (ART) can be personalized through simple formulations with high resistance barriers, favorable safety profiles, and novel administration routes. Switching treatments has become a key clinical strategy for addressing drug toxicity and interactions and enhancing adherence and convenience. This strategy aims to improve the quality of life and long-term efficacy, even in challenging cases like people living with HIV (PLWH) with multiple comorbidities, prior virological failure, and drug resistance. AREAS COVERED The authors reviewed clinical trials and cohort studies providing evidence of benefits and risks of current antiretroviral (ARV) drugs as switching options for PLWH in various scenarios. The literature search included clinical trials, meta-analyses, observational studies, and review articles in English published after 2000, and current HIV treatment guidelines in English and Spanish as of February 2024. EXPERT OPINION New ARV drugs offer advantages in efficacy and safety over previous options but may also have adverse effects. Second-generation integrase inhibitors and tenofovir alafenamide show benefits as switching options in various scenarios, though more research is needed on potential weight gain and metabolic issues. Injectable long-acting ART is promising for switching strategies, but finding the optimal combination of new drugs remains challenging.
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Affiliation(s)
- Analuz Fernández
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arkaitz Imaz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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14
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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024; 17:589-614. [PMID: 38753455 PMCID: PMC11233252 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N. Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H. Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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15
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Shroba J, Januszka J. Contemporary Treatment Approaches for Human Immunodeficiency Virus Infection: Association of Antiretrovirals with Weight Gain and Potential Solutions. Nurs Clin North Am 2024; 59:189-200. [PMID: 38670689 DOI: 10.1016/j.cnur.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Integrase inhibitors and tenofovir alafenamide have become a mainstay in modern antiretroviral therapy; more recently, they have been implicated as causing increased weight gain beyond what may be expected with the "return to health" phenomenon. Some patients, namely those assigned female at birth, of the black race, or with lower baseline CD4 counts, may be more likely to experience weight gain. This review outlines existing evidence linking the agents to excessive weight as well as ongoing efforts to combat these effects.
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Affiliation(s)
- Jenny Shroba
- Department of Pharmacy, Duke University Hospital, 40 Duke Medicine Circle, Durham, NC 27710, USA.
| | - Jenna Januszka
- Department of Pharmacy, Duke University Hospital, 40 Duke Medicine Circle, Durham, NC 27710, USA
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Mills AM, Rizzardini G, Ramgopal MN, Osiyemi OO, Bogner JR, Hagins DP, Paredes R, Reynes J, Rockstroh JK, Carr A, Su FH, Klopfer SO, Eves K, Plank RM, Correll T, Fox MC. Switch to fixed-dose doravirine (100 mg) with islatravir (0·75 mg) once daily in virologically suppressed adults with HIV-1 on bictegravir, emtricitabine, and tenofovir alafenamide: 48-week results of a phase 3, randomised, controlled, double-blind, non-inferiority trial. Lancet HIV 2024; 11:e357-e368. [PMID: 38734016 DOI: 10.1016/s2352-3018(24)00030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Doravirine and islatravir is an investigational, once-daily regimen with high antiviral potency, favourable safety and tolerability, and a low propensity for resistance. We investigated a switch from bictegravir, emtricitabine, and tenofovir alafenamide to doravirine (100 mg) and islatravir (0·75 mg) in virologically suppressed adults with HIV-1. METHODS We conducted a phase 3, multicentre, randomised, active-controlled, double-blind, double-dummy, non-inferiority trial at 89 research, community, and hospital-based clinics in 11 countries. Adults aged 18 years or older with fewer than 50 HIV-1 RNA copies per mL for at least 3 months on bictegravir (50 mg), emtricitabine (200 mg), and tenofovir alafenamide (25 mg) and no history of previous virological failure on any past or current regimen were randomly assigned (1:1) by a computer-generated randomisation allocation schedule, with block randomisation based on a block size of four, to switch to doravirine (100 mg) and islatravir (0·75 mg) or continue bictegravir, emtricitabine, and tenofovir alafenamide orally once daily, with matching placebos taken by all participants. Participants, investigators, study staff, and sponsor personnel involved in study drug administration or clinical evaluation of participants were masked to treatment assignment until week 48. Participants were instructed at each visit to take one tablet from each of the two bottles received, one of study drug and one of placebo, once daily, and participants were assessed at baseline and weeks 4, 12, 24, 36, and 48. The primary endpoint was the proportion of participants with greater than or equal to 50 HIV-1 RNA copies per mL at week 48 in the full analysis set (ie, all participants who received at least one dose of study drug; US Food and Drug Administration snapshot; prespecified non-inferiority margin 4%). The study is ongoing, with all remaining participants in post-treatment follow-up, and is registered with ClinicalTrials.gov, NCT04223791. FINDINGS We screened 726 individuals for eligibility between Feb 18 and Sept 3, 2020, of whom 643 (88·6%) participants were randomly assigned to a treatment group (183 [28·5%] women and 460 [71·5%] men). 322 participants were switched to doravirine (100 mg) and islatravir (0·75 mg) and 321 continued bictegravir, emtricitabine, and tenofovir alafenamide (two participants [one with a protocol deviation and one who withdrew] assigned to bictegravir, emtricitabine, and tenofovir alafenamide did not receive treatment). The last follow-up visit for the week 48 analysis occurred on Aug 26, 2021. At week 48, two (0·6%) of 322 participants in the doravirine and islatravir group compared with one (0·3%) of 319 participants in the bictegravir, emtricitabine, and tenofovir alafenamide group had greater than or equal to 50 HIV-1 RNA copies per mL (difference 0·3%, 95% CI -1·2 to 2·0). The per-protocol analysis showed consistent results. 25 (7·8%) participants in the doravirine and islatravir group had headache compared with 23 [7·2%] participants in the bictegravir, emtricitabine, and tenofovir alafenamide group; 101 (31·4%) compared with 98 (30·7%) had infections; and eight (2·5%) participants in each group discontinued therapy due to adverse events. 32 (9·9%) participants had treatment-related adverse events in the islatravir and doravirine group comapred with 38 (11·9%) in the bictegravir, emtricitabine, and tenofovir alafenamide group. In the islatravir and doravirine group, CD4 cell counts (mean change -19·7 cells per μL) and total lymphocyte counts (mean change -0·20 × 109/L) were decreased at 48 weeks. INTERPRETATION Switching to daily doravirine (100 mg) and islatravir (0·75 mg) was non-inferior to bictegravir, emtricitabine, and tenofovir alafenamide at week 48. However, decreases in CD4 cell and total lymphocyte counts do not support the further development of once-daily doravirine (100 mg) and islatravir (0·75 mg). FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co.
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Affiliation(s)
| | - Giuliano Rizzardini
- Hospital Sacco, Milan, Italy; School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Johannes R Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Roger Paredes
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; IrsiCaixa AIDS Research Institute, Badalona, Spain; Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jacques Reynes
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France; TransVIHMI, University of Montpellier, IRD, INSERM, Montpellier, France
| | | | - Andrew Carr
- Immunology and HIV Unit, St Vincent's Hospital, Sydney, NSW, Australia
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Molina JM, Rizzardini G, Orrell C, Afani A, Calmy A, Oka S, Hinestrosa F, Kumar P, Tebas P, Walmsley S, Grandhi A, Klopfer S, Gendrano I, Eves K, Correll TA, Fox MC, Kim J. Switch to fixed-dose doravirine (100 mg) with islatravir (0·75 mg) once daily in virologically suppressed adults with HIV-1 on antiretroviral therapy: 48-week results of a phase 3, randomised, open-label, non-inferiority trial. Lancet HIV 2024; 11:e369-e379. [PMID: 38734015 DOI: 10.1016/s2352-3018(24)00031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Doravirine and islatravir is an investigational, once-daily, single-tablet regimen with high antiviral potency, favourable safety and tolerability, and low propensity for resistance. We report week 48 results from a phase 3 trial evaluating switch from stable, oral antiretroviral therapy (ART) to the fixed combination of doravirine (100 mg) and islatravir (0·75 mg). METHODS This phase 3, multicentre, randomised, active-controlled, open-label, non-inferiority trial was conducted at 77 research, community, and hospital-based clinics in 15 countries. Adults aged 18 years or older with fewer than 50 HIV-1 RNA copies per mL on any oral, two-drug or three-drug ART regimen for at least 3 months, and no history of previous virological failure on any past or current regimen were randomly assigned (1:1) by a computer-generated randomisation schedule to switch to doravirine (100 mg) and islatravir (0·75 mg) or to continue their baseline ART regimen. Block randomisation was based on a block size of four, and randomisation was stratified by baseline regimen (ie, protease inhibitor, integrase inhibitor, or other). Participants in the doravirine and islatravir group were instructed to take one tablet at approximately the same time each day, and participants in the baseline ART group continued to take the medication according to the locally approved label. HIV-1 RNA and safety evaluations were done at baseline and weeks 4, 12, 24, 36, and 48. CD4 cell counts were measured at baseline, week 24, and week 48. The primary endpoint was proportion of participants with greater than or equal to 50 HIV-1 RNA copies per mL at week 48 in the full analysis set (ie, all participants who received at least one dose of study drug) using the US Food and Drug Administration snapshot approach and prespecified non-inferiority margin of 4%. This study is registered with ClinicalTrials.gov (NCT04223778) and is completed. FINDINGS Between Feb 18 and Oct 2, 2020, 740 individuals were screened for eligibility, of whom 672 (90·8%) participants (249 [37·1%] women and 423 [62·9%] men; median CD4 count of 678 cells per μL [IQR 496-868]) were randomly assigned to doravirine (100 mg) and islatravir (0·75 mg; n=336) or to continue baseline ART (n=336). The last follow-up visit occurred on Sept 8, 2021. At week 48, zero of 336 participants in the doravirine and islatravir group versus five (1·5%) of 336 participants in the baseline ART group had greater than or equal to 50 HIV-1 RNA copies per mL (difference -1·5, 95% CI -3·4 to -0·3). The per-protocol analysis showed consistent results. Headache was the most common adverse event in both groups (35 [10·4%] of 336 participants in the doravirine and islatravir group, 16 [4·8%] of 336 in the baseline ART group), infection rates were similar (113 [33·6%] in both groups), and discontinuations due to adverse events were low (seven [2·1%] vs one [0·3%]). 66 (19·6%) of 336 participants had treatment-related adverse events in the doravirine and islatravir group compared with 30 (8·9%) of 336 in the baseline ART group. In the islatravir and doravirine group, CD4 cell counts (mean change -30·3 cells per μL) and total lymphocyte counts (mean change -0·26 × 109/L) were decreased at 48 weeks. INTERPRETATION Switching to single-tablet doravirine (100 mg) and islatravir (0·75 mg) maintained viral suppression up to week 48 and was non-inferior to antiretroviral combinations used in clinical practice for adults with HIV-1; however, decreases in CD4 cell and total lymphocyte counts do not support further development of once-daily doravirine (100 mg) and islatravir (0·75 mg). FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co.
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Affiliation(s)
- Jean-Michel Molina
- St-Louis and Lariboisière Hospitals, APHP, University of Paris Cité, INSERM U944, Paris, France
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Hospital Luigi Sacco, Milan, Italy; School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Alejandro Afani
- Infectious Disease Department, University of Chile, Santiago, Chile
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Princy Kumar
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Pablo Tebas
- Penn Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Ontario, Canada
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Orkin C, Antinori A, Rockstroh JK, Moreno-Guillén S, Martorell CT, Molina JM, Lazzarin A, Maggiolo F, Yazdanpanah Y, Andreatta K, Huang H, Hindman JT, Martin H, Pozniak A. Switch to bictegravir/emtricitabine/tenofovir alafenamide from dolutegravir-based therapy. AIDS 2024; 38:983-991. [PMID: 38349226 PMCID: PMC11064918 DOI: 10.1097/qad.0000000000003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of 96 weeks of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) treatment in participants switching from dolutegravir (DTG)-based therapy. DESIGN Studies 1489 (NCT02607930) and 1490 (NCT02607956) were phase 3 randomized, double-blind, active-controlled, first-line therapy trials in people with HIV-1. After 144 weeks of DTG-based or B/F/TAF treatment, participants could enter a 96-week open-label extension (OLE) of B/F/TAF. METHODS A pooled analysis evaluated viral suppression (HIV-1 RNA <50 copies/ml) and changes in CD4 + cell count at OLE Weeks 48 and 96, treatment-emergent resistance, safety, and tolerability after switch from a DTG-based regimen to B/F/TAF. Outcomes by prior treatment were summarized using descriptive statistics and compared by two-sided Wilcoxon rank sum test. RESULTS At OLE Week 96, participants who switched to B/F/TAF ( N = 519) maintained high levels of virologic suppression (99.5 and 99.1% in those switching from DTG/abacavir/lamivudine and DTG+F/TAF, respectively) and CD4 + cell count, with no treatment-emergent resistance to B/F/TAF. Twenty-one participants experienced drug-related adverse events after switching, with diarrhea, weight gain, and headache occurring most commonly. There were no cases of proximal renal tubulopathy, drug-related Grade 4 adverse events, or serious adverse events. Two participants discontinued B/F/TAF due to treatment-related adverse events. Participants who switched from DTG/abacavir/lamivudine experienced statistically significant greater weight gain than those who switched from DTG+F/TAF; however, median weight change from the blinded phase baseline to OLE Week 96 was numerically similar across treatment groups. CONCLUSION This medium-term analysis demonstrates the safety and efficacy of switching to B/F/TAF from a DTG-containing regimen in people with HIV-1.
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Affiliation(s)
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | | | | | - Jean-Michel Molina
- University of Paris Cité, Department of Infectious Diseases, Hôpital Saint-Louis and Lariboisière, Paris, France
| | | | | | | | | | - Hailin Huang
- Gilead Sciences, Inc., Foster City, California, USA
| | | | - Hal Martin
- Gilead Sciences, Inc., Foster City, California, USA
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Wong A, Brunetta J, De Wet J, Logue K, Loemba H, Saifi T, Mumm D, Marongiu A, Harrison R, Thorpe D, Trottier B. Twelve-month effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide in people with HIV from the Canadian cohort of the observational BICSTaR study. Medicine (Baltimore) 2024; 103:e37785. [PMID: 38640301 PMCID: PMC11029942 DOI: 10.1097/md.0000000000037785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
The BICSTaR (BICtegravir Single Tablet Regimen) study is investigating the effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in people with human immunodeficiency virus (HIV) treated in routine clinical practice. BICSTaR is an ongoing, prospective, observational cohort study across 14 countries. Treatment-naïve (TN) and treatment-experienced (TE) people with HIV (≥18 years of age) are being followed for 24 months. We present an analysis of the primary endpoint (HIV-1 RNA < 50 copies/mL; missing-equals-excluded [M = E]) at month 12 in the BICSTaR Canada cohort, including secondary (CD4 count, CD4/CD8 ratio, safety/tolerability) and exploratory (persistence, treatment satisfaction) endpoints. In total, 201 participants were enrolled in the BICSTaR Canada cohort. The analysis population included 170 participants (TN, n = 10; TE, n = 160), with data collected between November 2018 and September 2020. Of the participants, 88% were male, 72% were White, and 90% had ≥ 1 comorbid condition(s). Median (quartile [Q]1-Q3) age was 50 (39-58) years and baseline CD4 count was 391.5 (109.0-581.0) cells/µL in TN participants and 586.0 (400.0-747.0) cells/µL in TE participants. After 12 months of B/F/TAF treatment, HIV-1 RNA was < 50 copies/mL in 100% (9/9) of TN-active participants and 97% (140/145) of TE-active participants (M = E analysis). Median (Q1-Q3) CD4 cell count increased by +195 (125-307) cells/µL in TN participants and by + 30 (-50 to 123) cells/µL in TE participants. Persistence on B/F/TAF was high through month 12 with 10% (1/10) of TN and 7 % (11/160) of TE participants discontinuing B/F/TAF within 12 months of initiation of treatment. No resistance to B/F/TAF emerged. Study drug-related adverse events occurred in 7% (12/169) of participants, leading to B/F/TAF discontinuation in 4 of 169 participants. Improvements in treatment satisfaction were observed in TE participants. B/F/TAF demonstrated high levels of effectiveness, persistence, and treatment satisfaction, and was well tolerated through month 12 in people with HIV treated in routine clinical practice in Canada.
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Affiliation(s)
| | | | | | - Ken Logue
- St Clair Medical Associates, Toronto, ON, Canada
| | | | - Taban Saifi
- Gilead Sciences Canada, Inc., Mississauga, ON, Canada
| | - Dylana Mumm
- Gilead Sciences Canada, Inc., Mississauga, ON, Canada
| | | | | | | | - Benoit Trottier
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, QC, Canada
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20
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Esser S, Brunetta J, Inciarte A, Levy I, D'Arminio Monforte A, Lambert JS, van Welzen B, Teruya K, Boffito M, Liu CE, Altuntas Aydın O, Thorpe D, Heinzkill M, Marongiu A, Cassidy T, Haubrich R, D'Amato L, Robineau O. Twelve-month effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide in people with HIV: Real-world insights from BICSTaR cohorts. HIV Med 2024; 25:440-453. [PMID: 38148567 DOI: 10.1111/hiv.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Real-world evidence is an essential component of evidence-based medicine. The aim of the BICSTaR (BICtegravir Single Tablet Regimen) study is to assess effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in antiretroviral treatment-naïve (TN) and treatment-experienced (TE) people with HIV. METHODS BICSTaR is a prospective, observational cohort study. Participants (≥18 years) are being followed for 24 months. A pooled analysis is presented at 12 months, with the primary endpoint of effectiveness (HIV-1 RNA <50 copies/mL) and secondary endpoints of safety and tolerability (as per protocol). An exploration of patient-reported outcome measures using standardized questionnaires is included. RESULTS Between June 2018 and May 2021, 1552 people with HIV were enrolled across 12 countries. The analysed population comprised 1509 individuals (279 TN, 1230 TE); most were white (76%), male (84%) and had one or more comorbid conditions (68%). Median age was 47 years. After 12 months of B/F/TAF treatment, HIV-1 RNA was <50 copies/mL in 94% (221/236) of TN participants and 97% (977/1008) of TE participants. Median CD4 cell count increased by 214 cells/μL (p < 0.001) in TN participants and 13 cells/μL (p = 0.014) in TE participants; median CD4/CD8 ratios increased by 0.30 and 0.03, respectively (both p < 0.001). Persistence was high at 12 months (TN, 97%; TE, 95%). No resistance to B/F/TAF emerged. Study drug-related adverse events occurred in 13% of participants through 12 months, leading to B/F/TAF discontinuation in 6%. CONCLUSIONS The findings of this study provide robust real-world evidence to support the broad use of B/F/TAF in both TN and TE people with HIV.
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Affiliation(s)
- Stefan Esser
- Clinic of Dermatology, Department of Venerology, University Hospital Essen, Essen, Germany
| | | | - Alexy Inciarte
- HIV Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antonella D'Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Sciences, University of Milan, "ASST Santi Paolo e Carlo", Milan, Italy
| | - John S Lambert
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Berend van Welzen
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Katsuji Teruya
- National Center for Global Health and Medicine: NCGM AIDS Clinical Center (ACC), Tokyo, Japan
| | | | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ozlem Altuntas Aydın
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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Walmsley S, Smith DE, Górgolas M, Cahn PE, Lutz T, Lacombe K, Kumar PN, Wynne B, Grove R, Bontempo G, Moodley R, Okoli C, Kisare M, Jones B, Clark A, Ait-Khaled M. Efficacy and safety of switching to dolutegravir/lamivudine in virologically suppressed people with HIV-1 aged ≥ 50 years: week 48 pooled results from the TANGO and SALSA studies. AIDS Res Ther 2024; 21:17. [PMID: 38515183 PMCID: PMC10958962 DOI: 10.1186/s12981-024-00604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND As the population of people with HIV ages, concerns over managing age-related comorbidities, polypharmacy, immune recovery, and drug-drug interactions while maintaining viral suppression have arisen. We present pooled TANGO and SALSA efficacy and safety results dichotomized by age (< 50 and ≥ 50 years). METHODS Week 48 data from the open-label phase 3 TANGO and SALSA trials evaluating switch to once-daily dolutegravir/lamivudine (DTG/3TC) fixed-dose combination vs continuing current antiretroviral regimen (CAR) were pooled. Proportions of participants with HIV-1 RNA ≥ 50 and < 50 copies/mL (Snapshot, intention-to-treat exposed) and safety were analyzed by age category. Adjusted mean change from baseline in CD4 + cell count was assessed using mixed-models repeated-measures analysis. RESULTS Of 1234 participants, 80% of whom were male, 29% were aged ≥ 50 years. Among those aged ≥ 50 years, 1/177 (< 1%) DTG/3TC participant and 3/187 (2%) CAR participants had HIV-1 RNA ≥ 50 copies/mL at 48 weeks; proportions with HIV-1 RNA < 50 copies/mL were high in both treatment groups (≥ 92%), consistent with overall efficacy and similar to observations in participants aged < 50 years (≥ 93%). Regardless of age category, CD4 + cell count increased or was maintained from baseline with DTG/3TC. Change from baseline in CD4 + /CD8 + ratio was similar across age groups and between treatment groups. One CAR participant aged < 50 years had confirmed virologic withdrawal, but no resistance was detected. In the DTG/3TC group, incidence of adverse events (AEs) was similar across age groups. Proportions of AEs leading to withdrawal were low and comparable between age groups. Although drug-related AEs were generally low, across age groups, drug-related AEs were more frequent in participants who switched to DTG/3TC compared with those who continued CAR. While few serious AEs were observed in both treatment groups, more were reported in participants aged ≥ 50 years vs < 50 years. CONCLUSIONS Among individuals with HIV-1, switching to DTG/3TC maintained high rates of virologic suppression and demonstrated a favorable safety profile, including in those aged ≥ 50 years despite higher prevalence of concomitant medication use and comorbidities. TRIAL REGISTRATION NUMBER TANGO, NCT03446573 (February 27, 2018); SALSA, NCT04021290 (July 16, 2019).
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Affiliation(s)
- Sharon Walmsley
- University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Don E Smith
- Albion Centre, 150 Albion Street, Surry Hills NSW 2010, Sydney, Australia
| | - Miguel Górgolas
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Pedro E Cahn
- Fundación Huésped, Dr. Carlos A. Gianantonio 3932, C1204 CABA, Buenos Aires, Argentina
| | - Thomas Lutz
- Infektiologikum, Stresemannallee 3, 60596, Frankfurt am Main, Frankfurt, Germany
| | - Karine Lacombe
- Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Princy N Kumar
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC, 20057, USA
| | - Brian Wynne
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Richard Grove
- GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Gilda Bontempo
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA
| | - Riya Moodley
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Chinyere Okoli
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Michelle Kisare
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
| | - Bryn Jones
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Andrew Clark
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Mounir Ait-Khaled
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
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22
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Abe K, Imamura J, Sasaki A, Suzuki T, Kamio S, Obara T, Ito T. Renal function and lipid metabolism in Japanese HIV-1-positive individuals 288 weeks after switching from tenofovir disoproxil fumarate to tenofovir alafenamide fumarate: a single-center, retrospective cohort study. J Pharm Health Care Sci 2024; 10:13. [PMID: 38419093 PMCID: PMC10900624 DOI: 10.1186/s40780-024-00336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Continued use of tenofovir disoproxil fumarate (TDF), an antiretroviral drug, causes renal function decline and tubular damage in individuals with HIV. While tenofovir alafenamide fumarate (TAF) may have less damaging effects, it causes weight gain and abnormal lipid metabolism. METHODS This single-center, retrospective cohort study used medical records from the National Hospital Organization Sendai Medical Center to investigate renal function of Japanese HIV-1-positive individuals who switched from TDF to antiretroviral therapy including TAF by 2017. The endpoints were: estimated glomerular filtration rate (eGFR), urinary β2 microglobulin (Uβ2MG), weight, and lipid metabolism parameters at 288 weeks after switching. Possible correlation between eGFR and Uβ2MG and factors affecting eGFR decline were examined. RESULTS Sixty patients switched from TDF to TAF and continued therapy for 288 weeks. eGFR showed a significant decline after 144 weeks, although it was controlled from the time of change until 96 weeks. In the renal impairment group, the decline was suppressed until week 288. Uβ2MG continued to decrease significantly after 48 weeks. However, the suggested correlation between eGFR and Uβ2MG disappeared when patients switched from TDF to TAF. Weight and lipid metabolic parameters increased significantly at 48 weeks and were maintained. Factors associated with decreased eGFR were: history of acquired immune deficiency syndrome (AIDS) and Uβ2MG. However, considering the odds ratio, the switch from TDF to TAF suppressed the eGFR decline in the group with a history of AIDS, and Uβ2MG had no effect on the eGFR decline. CONCLUSIONS Switching from TDF to TAF for the long term slows eGFR decline, decreases Uβ2MG levels, and reduces worsening of renal function. Weight gain and abnormal lipid metabolism may occur in the short term but are controllable.
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Affiliation(s)
- Kensuke Abe
- Department of Pharmacy, National Hospital Organization Morioka Medical Center, 1-25-1 Aoyama, Morioka, Iwate, 020-0133, Japan.
- Department of Clinical Research, National Hospital Organization Sendai Medical Center, 983-8520, Miyagino 2-11-12, Sendai, Japan.
| | - Junji Imamura
- HIV/AIDS Comprehensive Medical Center, National Hospital Organization Sendai Medical Center, 983-8520, Miyagino 2-11-12, Sendai, Japan
| | - Akiko Sasaki
- HIV/AIDS Comprehensive Medical Center, National Hospital Organization Sendai Medical Center, 983-8520, Miyagino 2-11-12, Sendai, Japan
| | - Tomoko Suzuki
- HIV/AIDS Comprehensive Medical Center, National Hospital Organization Sendai Medical Center, 983-8520, Miyagino 2-11-12, Sendai, Japan
| | - Satomi Kamio
- Department of Pharmacy, National Hospital Organization Shibukawa Medical Center, 377-0280, Shirai 383, Shibukawa, Japan
| | - Taku Obara
- Department of Pharmaceutical Scienses, Tohoku University Hospital, 980-8574, Seiryomachi 1-1, Sendai, Japan
| | - Toshihiro Ito
- HIV/AIDS Comprehensive Medical Center, National Hospital Organization Sendai Medical Center, 983-8520, Miyagino 2-11-12, Sendai, Japan
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23
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Taramasso L, Dettori S, Ricci E, Lerta S, Mora S, Blanchi S, Giacomini M, Vena A, Bassetti M, Di Biagio A. Weight Gain in Overweight and Obese People with HIV-The OBHIV Cohort. J Clin Med 2024; 13:1211. [PMID: 38592054 PMCID: PMC10932370 DOI: 10.3390/jcm13051211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND HIV and non-HIV-related factors have been related to weight gain (WG); however, their specific impact on people with HIV (PWH) who are overweight or obese remains unclear. METHODS This is a single-center observational study enrolling PWH with a BMI > 25 kg/m2. A generalized linear model was used to assess variables related to greater WG during 12 years of observation. RESULTS A total of 321 PWH were enrolled, 67% overweight and 33% obese, who gained an average of 0.2 ± 1.3 and 1.7 ± 1.5 kg/year, respectively (p < 0.0001). Years since HIV infection were the only variable significantly associated with WG (β -0.048, 95% CI -0.083; -0.013) during the study period, while type of ART did not influence the outcome. Narrowing the observation to the period of the SARS-CoV-2 pandemic, PWH with a longer duration of infection (β 0.075, 95% CI 0.033; 0.117) and a greater increase in triglycerides (β 0.005; 95% CI 0.000; 0.011) gained more weight, while higher BMI (β -0.256, 95% CI -0.352; -0.160), obesity (β -1.363, 95% CI -2.319; -0.408), diabetes mellitus (β -1.538, 95% CI -2.797; -0.278), and greater abdominal circumference (β -0.086, 95% CI -0.142; -0.030) resulted in protection. CONCLUSION Among overweight and obese PWH, the amount of WG was higher in the first years after diagnosis of HIV and decreased thereafter, despite aging, regardless of the type of ART.
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Affiliation(s)
- Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
| | - Silvia Dettori
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Elena Ricci
- Fondazione ASIA Onlus, Buccinasco, 20090 Milan, Italy;
| | - Sonia Lerta
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, 16126 Genoa, Italy; (S.M.); (M.G.)
| | - Sabrina Blanchi
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, 16126 Genoa, Italy; (S.M.); (M.G.)
| | - Antonio Vena
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Matteo Bassetti
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
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24
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Maman O, Ahmad WA, Perzon O, Mahlab-Guri K, Elbirt D, Elinav H. The effect of a treatment switch to integrase Strand transfer inhibitor-based regimens on weight gain and other metabolic syndrome-related conditions. BMC Infect Dis 2024; 24:221. [PMID: 38373940 PMCID: PMC10877751 DOI: 10.1186/s12879-024-09120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE This study aimed to assess weight gain associated with treatment switching to INSTI-based regimens in people living with HIV (PLWH) and to determine whether it is accompanied by worsening features of hypertension, dyslipidemia, or hyperglycemia. METHODS In this two-center retrospective observational study, we assessed weight gain and metabolic features in PLWH who switched to an INSTI-based regimen (study group) as compared to patients who remained on a non-INSTI regimen (control group) over a 24-month follow-up period. RESULTS One-hundred seventy-four PLWH were included in the study group, and 175 were included in the control group. The study group gained 2.51 kg ± 0.31 (mean ± standard deviation) over the 2 years of follow-up, while the control group gained 1.1 ± 0.31 kg over the same time course (p < 0.001). INSTI treatment, Caucasian origin, and lower BMI were risk factors associated with excessive weight gain during the 2 years of follow-up. Among metabolic parameters, only glucose levels increased after initiating INSTI-based regimens, although limited to males of African origin (p = 0.009). CONCLUSIONS We observed a mild weight gain after switching to INSTI-based regimens, with no major impact on metabolic parameters over 2 years of follow-up. Longer follow-up might be needed to observe the adverse metabolic effects of INSTI-based regimens. The impact on weight gain should be discussed with every patient before the treatment switch to ensure a balanced diet and physical activity to prevent excessive weight gain that might hamper compliance with ART.
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Affiliation(s)
- Omer Maman
- Medical School, Hebrew University, Jerusalem, Israel
- Imaging division, Radiology department, Sourasky medical center-Ichilov, Tel Aviv, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | - Ofer Perzon
- Internal medicine ward B, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Keren Mahlab-Guri
- Department of Allergy, Immunology and HIV, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Elbirt
- Department of Allergy, Immunology and HIV, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hila Elinav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Hadassah AIDS Center, Department of Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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25
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Orkin C, Molina JM, Cahn P, Lombaard J, Supparatpinyo K, Kumar S, Campbell H, Wan H, Teal V, Jin Xu Z, Asante-Appiah E, Sklar P, Teppler H, Lahoulou R. Safety and efficacy of doravirine as first-line therapy in adults with HIV-1: week 192 results from the open-label extensions of the DRIVE-FORWARD and DRIVE-AHEAD phase 3 trials. Lancet HIV 2024; 11:e75-e85. [PMID: 38141637 DOI: 10.1016/s2352-3018(23)00258-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In two phase 3 trials for first-line therapy in adults with HIV-1, doravirine showed non-inferior efficacy, a favourable safety profile, and a superior lipid profile to darunavir and efavirenz through to 48 and 96 weeks. Here we report 192-week results from both studies. METHODS DRIVE-FORWARD and DRIVE-AHEAD are multicentre, double-blind, randomised, active comparator-controlled, phase 3 trials of first-line antiretroviral treatment in adults with HIV-1. Eligible participants (aged ≥18 years) were naive to antiretroviral therapy, had plasma HIV-1 RNA 1000 copies per mL or more at screening, had no known resistance to any of the trial drugs, and had creatinine clearance 50 mL per min or more. DRIVE-FORWARD was conducted at 125 sites in 15 countries and compared doravirine (100 mg) with ritonavir-boosted darunavir (ritonavir [100 mg] and darunavir [800 mg]), each administered orally once daily with two nucleoside or nucleotide reverse transcriptase inhibitors (tenofovir disoproxil fumarate [300 mg] and emtricitabine [200 mg] or abacavir sulfate [600 mg] and lamivudine [300 mg]). DRIVE-AHEAD was conducted at 126 sites in 23 countries and compared doravirine (100 mg), lamivudine (300 mg), and tenofovir disoproxil fumarate (300 mg) with that of efavirenz (600 mg), emtricitabine (200 mg), and tenofovir disoproxil fumarate (300 mg), all administered orally once daily. DRIVE-FORWARD enrolment was between Dec 1, 2014, and June 1, 2020, and DRIVE-AHEAD enrolment was between June 10, 2015, and Aug 10, 2020. After the 96-week double-blind phase, eligible participants could enter an open-label extension and either continue doravirine or switch from comparator to doravirine for an additional 96 weeks. Efficacy (HIV-1 RNA <50 copies per mL) and safety assessments (adverse events and changes in laboratory parameters) were pooled. The DRIVE-FORWARD and DRIVE-AHEAD trials were registered with ClinicalTrials.gov, NCT02275780 and NCT02403674. FINDINGS Of 1494 participants treated in the double-blind phase (1261 [84%] male and 233 [16%] female), 550 continued doravirine and 502 switched to doravirine in the extension. Using the FDA snapshot approach, HIV-1 RNA less than 50 copies per mL was maintained in 457 (83%) of 550 participants who continued doravirine and 404 (80%) of 502 participants who switched to doravirine. Protocol-defined virological failure and development of resistance were low, occurring mainly before week 96. Two (<1%) of 550 participants who continued doravirine reported serious drug-related adverse events, and three (1%) who continued doravirine and one (<1%) of 502 who switched to doravirine discontinued due to drug-related adverse events. Participants continuing or switching to doravirine showed generally favourable lipid profiles, little weight gain, and small decreases in estimated glomerular filtration rates, with no discontinuations due to increased creatinine or renal adverse events. INTERPRETATION Favourable efficacy and safety profiles for doravirine at week 96 were maintained through to week 192 in participants who continued or switched to doravirine, supporting use of doravirine for long-term first-line HIV-1 treatment and for virologically suppressed adults switching therapy. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co, Rahway, NJ, USA.
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Affiliation(s)
| | - Jean-Michel Molina
- University of Paris, Department of Infectious Diseases, St-Louis and Lariboisière Hospitals, Assistance Publique Hôpitaux de Paris, and University of Paris Cité, Paris, France
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
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Lam JO, Leyden WA, Alexeeff S, Lea AN, Hechter RC, Hu H, Marcus JL, Pitts L, Yuan Q, Towner WJ, Horberg MA, Silverberg MJ. Changes in Body Mass Index Over Time in People With and Without HIV Infection. Open Forum Infect Dis 2024; 11:ofad611. [PMID: 38323078 PMCID: PMC10846771 DOI: 10.1093/ofid/ofad611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
Background Excess weight gain is an important health concern among people with HIV (PWH) on antiretroviral therapy (ART). The extent to which ART contributes to body mass index (BMI) changes is incompletely understood. Methods We conducted a retrospective study of PWH initiating ART and demographically matched people without HIV (PWoH). Data on baseline BMI (kg/m2; categorized as underweight/normal, overweight, or obese) and ART class (integrase strand transfer inhibitor [INSTI], non-nucleoside reverse transcriptase inhibitor [NNRTI], protease inhibitor [PI]) were obtained from electronic health records. BMI was evaluated longitudinally using piecewise linear splines in mixed effects models by HIV status, baseline BMI, and ART class. Models were adjusted for sociodemographics, comorbidities, and substance use. Results The study included 8256 PWH and 129 966 PWoH (mean baseline age, 40.9 and 42.2 years, respectively; 88% men). In adjusted models, the average annual change in BMI in the first 2 years after ART initiation was 0.53 for PWH and 0.12 for PWoH (P < .001). BMI increases among PWH were observed for all ART classes: 0.69 for INSTIs, 0.69 for PIs, and 0.40 for NNRTIs vs 0.12 among PWoH. For PWH initiating INSTIs, BMI increases were observed regardless of baseline BMI. Overall BMI changes >2 years after ART initiation were similar by HIV status (0.02 average annual increase for PWH and PWoH). Conclusions PWH initiating ART gained excess weight in the first 2 years, emphasizing the importance of monitoring weight and cardiometabolic health among ART-treated PWH.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Lakecia Pitts
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Qing Yuan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Michael A Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Wu K, Koethe J, Hulgan T, Brown T, Bares SH, Tassiopoulos K, Lake JE, Leonard M, Samuels DC, Erlandson K, Haas DW. Pharmacogenetics of weight gain following switch from efavirenz- to integrase inhibitor-containing regimens. Pharmacogenet Genomics 2024; 34:25-32. [PMID: 37910437 PMCID: PMC10732300 DOI: 10.1097/fpc.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Excessive weight gain affects some persons with HIV after switching to integrase strand transfer inhibitor (INSTI)-containing antiretroviral therapy (ART). We studied associations between CYP2B6 genotype and weight gain after ART switch among ACTG A5001 and A5322 participants. METHODS Eligible participants switched from efavirenz- to INSTI-containing ART, had genotype data, and had weight data at least once from 4 weeks to 2 years post-switch. Multivariable linear mixed effects models adjusted for race/ethnicity, CD4, age, BMI and INSTI type assessed relationships between CYP2B6 genotype and estimated differences in weight change. RESULTS A total of 159 eligible participants switched ART from 2007 to 2019, of whom 138 had plasma HIV-1 RNA < 200 copies/mL (65 CYP2B6 normal, 56 intermediate, 17 poor metabolizers). Among participants with switch HIV-1 RNA < 200 copies/mL, weight increased in all 3 CYP2B6 groups. The rate of weight gain was greater in CYP2B6 poor than in CYP2B6 normal metabolizers overall, and within 9 subgroups (male, female, White, Black, Hispanic, dolutegravir, elvitegravir, raltegravir, and TDF in the pre-switch regimen); only in Hispanic and elvitegravir subgroups were these associations statistically significant ( P < 0.05). Compared to normal metabolizers, CYP2B6 intermediate status was not consistently associated with weight gain. CONCLUSION CYP2B6 poor metabolizer genotype was associated with greater weight gain after switch from efavirenz- to INSTI-containing ART, but results were inconsistent. Weight gain in this setting is likely complex and multifactorial.
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Affiliation(s)
- Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - John Koethe
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Hulgan
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Brown
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Sara H. Bares
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jordan E. Lake
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at Houston, Houston, Texas
| | - Michael Leonard
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David C. Samuels
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
| | - Kristine Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David W. Haas
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
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Chen CH, Hsieh YY, Chen WM, Shen CH, Wei KL, Chang KC, Ding YJ, Lu SN, Hung CH, Chang TS. Weight Gain and Increased Body Mass Index in Patients with Hepatitis C after Eradication Using Direct-Acting Antiviral Therapy in Taiwan. Diagnostics (Basel) 2024; 14:213. [PMID: 38275460 PMCID: PMC10814234 DOI: 10.3390/diagnostics14020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Few studies have reported weight gain in patients with hepatitis C virus (HCV) infection treated with direct-acting antiviral agents (DAAs). This retrospective cohort study identified factors associated with substantial weight gain after DAA treatment in Taiwan. This study involved patients treated using DAAs at the Chiayi and Yunlin branches of Chang Gung Memorial Hospital from 1 January 2017 to 31 October 2020. Body weight data were collected at the start of DAA therapy and 2 years after the confirmation of a sustained virologic response. We performed multiple logistic regression to evaluate the clinical and laboratory parameters associated with a large body mass index (BMI) increase (≥5%). The mean BMI was 25.56 ± 4.07 kg/m2 at baseline and 25.77 ± 4.29 kg/m2 at the endpoint (p = 0.005). A considerable reduction in fibrosis-4 (FIB-4) score was a significant predictor of a large BMI increase (OR: 1.168; 95% CI: 1.047-1.304, p = 0.006). By contrast, older age (OR: 0.979; 95% CI: 0.963-0.996, p = 0.013) and a higher baseline BMI (OR: 0.907; 95% CI: 0.863-0.954, p < 0.001) were associated with a reduced risk of a large increase in BMI at the endpoint. In summary, a larger BMI increase was closely associated with a younger age, lower baseline BMI, and higher FIB-4 score reduction. Notably, differences in DAA regimens did not affect outcomes. Future studies are needed to elucidate the long-term effects and metabolic outcomes associated with this body weight change and investigate the exact underlying mechanisms.
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Affiliation(s)
- Chun-Hsien Chen
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
| | - Yung-Yu Hsieh
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
| | - Wei-Ming Chen
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
| | - Chien-Heng Shen
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
| | - Kuo-Liang Wei
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
| | - Kao-Chi Chang
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
| | - Yuan-Jie Ding
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
| | - Sheng-Nan Lu
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chao-Hung Hung
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Te-Sheng Chang
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-H.C.)
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
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Chandiwana NC, Siedner MJ, Marconi VC, Hill A, Ali MK, Batterham RL, Venter WDF. Weight Gain After HIV Therapy Initiation: Pathophysiology and Implications. J Clin Endocrinol Metab 2024; 109:e478-e487. [PMID: 37437159 PMCID: PMC10795932 DOI: 10.1210/clinem/dgad411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
Rapid advances in the potency, safety, and availability of modern HIV antiretroviral therapy (ART) have yielded a near-normal life expectancy for most people living with HIV (PLWH). Ironically, considering the history of HIV/AIDS (initially called "slim disease" because of associated weight loss), the latest dilemma faced by many people starting HIV therapy is weight gain and obesity, particularly Black people, women, and those who commenced treatment with advanced immunodeficiency. We review the pathophysiology and implications of weight gain among PLWH on ART and discuss why this phenomenon was recognized only recently, despite the availability of effective therapy for nearly 30 years. We comprehensively explore the theories of the causes, from initial speculation that weight gain was simply a return to health for people recovering from wasting to comparative effects of newer regimens vs prior toxic agents, to direct effects of agents on mitochondrial function. We then discuss the implications of weight gain on modern ART, particularly concomitant effects on lipids, glucose metabolism, and inflammatory markers. Finally, we discuss intervention options for PLWH and obesity, from the limitations of switching ART regimens or specific agents within regimens, weight-gain mitigation strategies, and potential hope in access to emerging antiobesity agents, which are yet to be evaluated in this population.
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Affiliation(s)
- Nomathemba C Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Vincent C Marconi
- Division of Infectious Diseases and Department of Global Health, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 4223, USA
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 7BE, UK
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 4223, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | | | - Willem Daniel Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Department of Public Health Medicine, Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa
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Erlandson KM, Mohaweche R, Morrow M, Mawhinney S, Khuu V, Boyd M, Balasubramanyam A, Melanson EL, Lake JE. Energy balance and body composition after switch between integrase strand transfer inhibitors and doravirine among people with HIV. J Antimicrob Chemother 2024; 79:179-185. [PMID: 38000089 PMCID: PMC10761240 DOI: 10.1093/jac/dkad363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are associated with excessive weight gain among a subset of persons with HIV (PWH), due to unclear mechanisms. We assessed energy intake (EI) and expenditure (EE) following switch off and onto INSTIs. METHODS PWH with >10% weight gain on an INSTI-based regimen switched INSTI to doravirine for 12 weeks, then back to INSTI for 12 weeks while keeping their remaining regimen stable. Twenty-four-hour EE, EI and weight were measured on INSTI, following switch to doravirine, and upon INSTI restart. Mixed models analysed changes over time. RESULTS Among 18 participants, unadjusted 24 h EE decreased by 83 (95% CI -181 to 14) kcal following switch to doravirine, and by 2 (-105 to 100) kcal after INSTI restart; energy balance (EE-EI) increased by 266 (-126 to 658) kcal from Week 0 to Week 12, and decreased by 3 (-429 to 423) kcal from Week 12 to Week 24. Trends toward weight loss occurred following switch to doravirine [mean -1.25 (-3.18 to 0.69) kg] and when back on INSTI [-0.47 (-2.45 to 1.52) kg]. Trunk fat decreased on doravirine [-474 (-1398 to 449) g], with some regain following INSTI restart [199 (-747 to 1145) g]. Fat-free mass decreased on doravirine [-491 (-1399 to 417) g] and increased slightly after INSTI restart [178 (-753 to 1108) g]. CONCLUSIONS Among PWH with >10% weight gain on an INSTI, switch to doravirine was associated with a trend towards decreases in 24 h EE, weight, trunk fat mass and fat-free mass. Observed changes were not significant, but suggest a mild weight-suppressive effect of doravirine among PWH.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Ruda Mohaweche
- Department of Medicine, UTHealth Houston, Houston, TX, USA
| | - Mary Morrow
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Samantha Mawhinney
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Vincent Khuu
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Mallory Boyd
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | | | - Edward L Melanson
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Jordan E Lake
- Department of Medicine, UTHealth Houston, Houston, TX, USA
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Millman N, Koethe JR, Erlandson KM. Obesity among women with HIV. Curr Opin HIV AIDS 2024; 19:30-34. [PMID: 37909915 PMCID: PMC10842230 DOI: 10.1097/coh.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW With the introduction of novel and more potent antiretroviral therapies (ART), persons with HIV (PWH) are living longer lives and experiencing higher rates of age- and weight-related comorbidities, including cardiovascular and metabolic diseases. Women with HIV (WWH) experience disproportionate rates of obesity, as evidenced by longitudinal observational cohorts both in the United States and globally. RECENT FINDINGS In this article, we aim to review major research findings regarding WWH and obesity over the past few years. Multiple studies have evaluated geographic changes in the obesity epidemic across the globe with focus on developing countries who have seen a drastic change in obesity rates. Other new data assessed the effect of antiretroviral therapy on WWH, the cardiovascular effects of obesity in women on ART including data from the recently published REPRIEVE Trial, and issues unique to women, such as pregnancy and the effect of menopause on WWH. SUMMARY Comorbid cardiometabolic conditions are rapidly increasing, in correlation with the obesity epidemic among PWH. WWH may be disproportionately impacted, and experience further effects of obesity, compounded by health disparities in many areas of the world. Further research on the most effective interventions to minimize weight gains and decrease obesity among WWH are urgently needed.
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Motta F, Milic J, Gozzi L, Belli M, Sighinolfi L, Cuomo G, Carli F, Dolci G, Iadisernia V, Burastero G, Mussini C, Missier P, Mandreoli F, Guaraldi G. A Machine Learning Approach to Predict Weight Change in ART-Experienced People Living With HIV. J Acquir Immune Defic Syndr 2023; 94:474-481. [PMID: 37949448 DOI: 10.1097/qai.0000000000003302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/03/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION The objective of the study was to develop machine learning (ML) models that predict the percentage weight change in each interval of time in antiretroviral therapy-experienced people living with HIV. METHODS This was an observational study that comprised consecutive people living with HIV attending Modena HIV Metabolic Clinic with at least 2 visits. Data were partitioned in an 80/20 training/test set to generate 10 progressively parsimonious predictive ML models. Weight gain was defined as any weight change >5%, at the next visit. SHapley Additive exPlanations values were used to quantify the positive or negative impact of any single variable included in each model on the predicted weight changes. RESULTS A total of 3,321 patients generated 18,322 observations. At the last observation, the median age was 50 years and 69% patients were male. Model 1 (the only 1 including body composition assessed with dual-energy x-ray absorptiometry) had an accuracy greater than 90%. This model could predict weight at the next visit with an error of <5%. CONCLUSIONS ML models with the inclusion of body composition and metabolic and endocrinological variables had an excellent performance. The parsimonious models available in standard clinical evaluation are insufficient to obtain reliable prediction, but are good enough to predict who will not experience weight gain.
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Affiliation(s)
- Federico Motta
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena, Italy
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Licia Gozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Michela Belli
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Laura Sighinolfi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Federica Carli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giovanni Dolci
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vittorio Iadisernia
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giulia Burastero
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Paolo Missier
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; and
| | - Federica Mandreoli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena, Italy
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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Han WM, Apornpong T, Lwin HMS, Thammapiwan S, Boonrungsirisap J, Gatechompol S, Ubolyam S, Tangkijvanich P, Kerr SJ, Avihingsanon A. Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis With Liver Fibrosis as Predictors of New-Onset Diabetes Mellitus in People With HIV: A Longitudinal Cohort Study. Clin Infect Dis 2023; 77:1687-1695. [PMID: 37477514 DOI: 10.1093/cid/ciad433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND We investigated the association between nonalcoholic fatty liver disease (NAFLD) plus or minus a concurrent diagnosis of nonalcoholic steatohepatitis (NASH) and incident diabetes mellitus (DM) and the risk factors associated with NAFLD or NASH development. METHODS In this prospective study, we analyzed people with human immunodeficiency virus (HIV; PWH) aged ≥18 years without excessive alcohol consumption or hepatitis coinfections. NAFLD was defined as controlled attenuation parameter ≥248 dB/m, whereas NASH with significant disease activity and liver fibrosis was defined as a FibroScan-AST score ≥0.67. Cox proportional hazard regression was used to investigate the association between NAFLD with or without NASH and new-onset DM. RESULTS Of 847 PWH, the median age at baseline was 45 years (interquartile range, 38-51; 43% female). Baseline NAFLD was associated with 2.8-fold higher risk of new-onset DM after adjusting for age, sex, family history of DM, antiretroviral therapy duration, smoking, statin use, stavudine/didanosine/zidovudine exposure, time-updated body mass index, hypertension, and dyslipidemia. Combined NAFLD and NASH at baseline had 3.1-fold higher new-onset DM risk. In separate analyses, baseline DM did not predict progression to NAFLD or NASH, but tenofovir alafenamide use was associated with an increased risk of NAFLD (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.02-4.02) or NASH development (2.31; 95% CI, 1.12-5.11). CONCLUSIONS NAFLD alone or combined with NASH strongly predicts new-onset DM. This highlights the need for systematic risk assessments and management of NAFLD/NASH, as it may contribute to metabolic complications such as DM and subsequent cardiovascular diseases in PWH.
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Affiliation(s)
- Win Min Han
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Center of Excellence in Tuberculosis, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanakorn Apornpong
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Hay Mar Su Lwin
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Siwat Thammapiwan
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jedsadakorn Boonrungsirisap
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Sivaporn Gatechompol
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Center of Excellence in Tuberculosis, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sasiwimol Ubolyam
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Center of Excellence in Tuberculosis, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Center of Excellence in Tuberculosis, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Bourgi K, Ofner S, Musick B, Wools-Kaloustian K, Humphrey JM, Diero L, Yiannoutsos CT, Gupta SK. Preswitch Regimens Influence the Rate of Weight Gain After Switch to Tenofovir Disoproxil Fumarate, Lamivudine, and Dolutegravir (TLD): Study From an East African Cohort. Open Forum Infect Dis 2023; 10:ofad581. [PMID: 38088979 PMCID: PMC10715773 DOI: 10.1093/ofid/ofad581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 12/30/2023] Open
Abstract
Background Switching from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens to dolutegravir (DTG) has been associated with greater weight gain. Methods We conducted our analysis using a longitudinal cohort of people with HIV (PWH) in Western Kenya. We evaluated changes in the rate of weight gain among treatment-experienced, virally suppressed PWH who switched from NNRTI to tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). We modeled the weights pre- and postswitch using a 2-phase model with linear trend preswitch and an inverted exponential function postswitch. We estimated an 18-month excess weight gain by comparing the projected weight with that expected using the preswitch rate. Results A total of 18 662 individuals were included in our analysis, with 55% switching from efavirenz (EFV) and 45% from nevirapine (NVP). Of the studied individuals, 51% were female, and the median age and body mass index (BMI) were 51 years and 22 kg/m2, respectively. For the overall population, the rate of weight gain increased from 0.47 kg/year preswitch to 0.77 kg/year, with higher increases for females (0.57 kg/year to 0.96 kg/year) than males (0.34 kg/year to 0.62 kg/year). The rate of weight gain for individuals switching from EFV-based regimens significantly increased from 0.57 kg/year preswitch to 1.11 kg/year postswitch but remained stable at 0.35 kg/year preswitch vs 0.32 kg/year postswitch for individuals switching from NVP-based regimens. Conclusions Switching from NNRTI-based regimens to TLD is associated with a modest increase in the rate of weight gain, with the preswitch NNRTI being the key determinant of the amount of weight gain experienced postswitch.
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Affiliation(s)
- Kassem Bourgi
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John M Humphrey
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lameck Diero
- School of Medicine, Department of Medicine, College of Health Sciences, Moi University Eldoret, Eldoret, Kenya
| | - Constantin T Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University R.M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Samir K Gupta
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Rocabert A, Borjabad B, Berrocal L, Blanch J, Inciarte A, Chivite I, Gonzalez-Cordon A, Torres B, Ambrosioni J, Martinez-Rebollar M, Laguno M, De La Mora L, Foncillas A, Sempere A, Rodriguez A, Solbes E, Llobet R, Miro JM, Mallolas J, Blanco JL, De Lazzari E, Martinez E. Tolerability of bictegravir/tenofovir alafenamide/emtricitabine versus dolutegravir/lamivudine as maintenance therapy in a real-life setting. J Antimicrob Chemother 2023; 78:2961-2967. [PMID: 37875023 DOI: 10.1093/jac/dkad338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND While both the burden of therapy and the individual drugs in bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) and dolutegravir/lamivudine differ, it is unclear whether their real-life tolerability may be also different. METHODS Single-centre, clinical cohort analysis of all virologically suppressed persons with HIV (PWH) who were first prescribed bictegravir as BIC/TAF/FTC or dolutegravir as dolutegravir/lamivudine and had taken ≥1 dose of study medication. Major outcomes were discontinuations either for any reason or due to toxicity. Incidence was calculated as number of episodes per 100 person-years adjusted through propensity score analysis. RESULTS Relative to persons treated with BIC/TAF/FTC (n = 1231), persons treated with dolutegravir/lamivudine (n = 821) were older and had more AIDS-defining conditions although better HIV control. After a median follow-up of 52 weeks, adjusted incidence rates for discontinuation were 6.68 (95% CI 5.18-8.19) and 8.44 (95% CI 6.29-10.60) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.26 (95% CI 0.89-1.78) relative to BIC/TAF/FTC (P = 0.1847). Adjusted incidence rates for discontinuation due to toxicity were 3.88 (95% CI 2.70-5.06) and 4.62 (95% CI 3.05-6.19) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.19 (95% CI 0.75-1.90) relative to BIC/TAF/FTC (P = 0. 4620). Adverse events leading to discontinuation were neuropsychiatric (n = 42; 2%), followed by gastrointestinal (n = 23; 1%), dermatological (n = 15; 1%) and weight increase (n = 15; 1%), without differences between regimens. CONCLUSIONS Switching to BIC/TAF/FTC or dolutegravir/lamivudine showed no difference in the risks of overall or toxicity-related discontinuations or in the profile of adverse events leading to discontinuation.
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Affiliation(s)
- Alba Rocabert
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Beatriz Borjabad
- Service of Internal Medicine, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Leire Berrocal
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordi Blanch
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ivan Chivite
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Berta Torres
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Martinez-Rebollar
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Laguno
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Abiu Sempere
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Rodriguez
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Estela Solbes
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Roger Llobet
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Mallolas
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose L Blanco
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa De Lazzari
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Martinez
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Mansour M, Augustine M, Kumar M, Butt AN, Thugu TR, Kaur P, Patel NJ, Gaudani A, Jahania MB, Jami E, Sharifa M, Raj R, Mehmood D. Frailty in Aging HIV-Positive Individuals: An Evolving Healthcare Landscape. Cureus 2023; 15:e50539. [PMID: 38222136 PMCID: PMC10787848 DOI: 10.7759/cureus.50539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
The life expectancy of people living with HIV (PLWH) has greatly increased due to advancements in combination antiretroviral treatment (cART). However, this longer life has also increased the prevalence of age-related comorbidities, such as frailty, which now manifest sooner in this group. Frailty, a term coined by the insurance industry, has been broadened to include physical, cognitive, and emotional elements and has been recognized as a critical predictor of negative health outcomes. With the median age of PLWH now in the mid-50s, treating frailty is critical given its link to chronic diseases, cognitive decline, and even death. Frailty assessment tools, such as the Frailty Phenotype (FP) and the Frailty Index (FI), are used to identify vulnerable people. Understanding the pathophysiology of frailty in PLWH indicates the role of immunological mechanisms. Frailty screening and management in this group have progressed, with specialized clinics and programs concentrating on multidisciplinary care. Potential pharmacotherapeutic solutions, as well as novel e-health programs and sensors, are in the future of frailty treatment, but it is critical to ensure that frailty evaluation is not exploited to perpetuate ageist healthcare practices. This narrative review investigates the changing healthcare environment for older people living with HIV (OPLWH), notably in high-income countries. It emphasizes the significance of identifying and managing frailty as a crucial feature of OPLWH's holistic care and well-being.
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Affiliation(s)
- Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | | | - Mahendra Kumar
- Medicine, Sardar Patel Medical College, Bikaner, Bikaner, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Thanmai Reddy Thugu
- Internal Medicine, Sri Padmavathi Medical College for Women, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, IND
| | - Parvinder Kaur
- Internal Medicine, Crimean State Medical University, Simferopol, UKR
| | | | - Ankit Gaudani
- Graduate Medical Education, Jiangsu University, Zhenjiang, CHN
| | - M Bilal Jahania
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Dalia Mehmood
- Community Medicine, Fatima Jinnah Medical University, Lahore, PAK
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37
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Drago F, Soshnik-Schierling L, Cabling ML, Pattarabanjird T, Desderius B, Nyanza E, Raymond H, McNamara CA, Peck RN, Shiau S. Characterizing blood pressure trajectories in people living with HIV following antiretroviral therapy: A systematic review. HIV Med 2023; 24:1106-1114. [PMID: 37474730 PMCID: PMC10799172 DOI: 10.1111/hiv.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The advent of antiretroviral therapy (ART) has reduced AIDS-related morbidity and mortality among people living with HIV (PLWH). Due to increased survival, PLWH have now been found to be at risk of chronic conditions related to ageing, such as cardiovascular disease (CVD). Hypertension is common in PLWH and is a major risk factor for the development of CVD. We conducted a systematic literature review to evaluate the research evidence on longitudinal blood pressure (BP) trajectories following ART initiation in PLWH. METHODS We searched the following databases: PubMed, CINHAL, Scopus, and Web of Science (up to 15 March 2021) for peer-reviewed published studies that reported BP trajectories following ART initiation in PLWH. Three reviewers independently screened all studies by title and abstract. We included articles in English, published up to March 2021, that report office BP trajectories in PLWH initiating ART. A total of 10 publications met our inclusion criteria. Eight studies were prospective cohorts and two were retrospective. RESULTS Nine out of 10 studies in the literature reported an increase in systolic BP (4.7-10.0 mmHg in studies with a follow-up range of 6 months to 8 years, and 3.0-4.7 mmHg/year in time-averaged studies). In addition, four out of 10 studies reported increases in diastolic BP (2.3-8.0 mmHg for a 6 month to 6.8-year follow-up range and 2.3 mmHg/year). CONCLUSION Systolic BP consistently increases while diastolic BP changes are more heterogeneous following ART initiation in PLWH. However, the studies were highly variable with respect to population demographics, ART regimen and duration, and follow-up time. Nevertheless, given the risks of CVD complications, such as stroke, heart failure and myocardial infarction, associated with elevated BP, results highlight the importance of future research in this area. It will be important to better characterize BP trajectories over time, identify the most critical times for interventions to reduce BP, determine the long-term CVD consequences in PLWH with elevated BP, and understand how different ART regimens may or may not influence BP and CVD disease.
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Affiliation(s)
- Fabrizio Drago
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | | | - Mark L. Cabling
- Department of English, Communication, and Society, King’s College London, London, United Kingdom
| | - Tanyaporn Pattarabanjird
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Bernard Desderius
- School of medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Elias Nyanza
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Henry Raymond
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Coleen A. McNamara
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Robert N. Peck
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, United State
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
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38
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Wood BR. Reassuring Data for Cardiovascular Health After Switching a Boosted Protease Inhibitor to Dolutegravir. Clin Infect Dis 2023; 77:1010-1011. [PMID: 37207616 DOI: 10.1093/cid/ciad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Brian R Wood
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
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Verburgh ML, Wit FW, Boyd A, Reiss P, Van der Valk M. No evidence of rapid reversibility of tenofovir alafenamide and/or integrase strand transfer inhibitor-associated weight gain. AIDS 2023; 37:1843-1850. [PMID: 37433218 PMCID: PMC10481918 DOI: 10.1097/qad.0000000000003654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE We aimed to determine the reversibility of at least 7% weight gain within 12 months following tenofovir alafenamide (TAF) and/or integrase strand transfer inhibitor (INSTI) discontinuation in people with HIV (PWH) from the Dutch ATHENA cohort. DESIGN AND METHODS PWH with at least 7% weight gain within 24 months after first switch to TAF and/or INSTI whilst being virally suppressed were selected, excluding those with comorbidities/co-medication known to be associated with weight gain. PWH who discontinued only TAF, only INSTI or TAF+INSTI, with available follow-up weight, were included. Mean weight change in the 24 months prior to and 12 months after discontinuation was modelled using mixed-effects linear regression. Factors associated with yearly weight change were assessed using linear regression. RESULTS In 115 PWH, discontinuing only TAF ( n = 39), only INSTI ( n = 53) or TAF+INSTI ( n = 23), the adjusted mean modelled weight change in the 24 months prior to discontinuation was +4.50 kg [95% confidence interval (CI) 3.04-6.10], +4.80 kg (95% CI 2.43-7.03) and +4.13 kg (95% CI 1.50-7.13), respectively, and -1.89 kg (95% CI -3.40 to -0.37), -1.93 kg (95% CI -3.92 to +0.07) and -2.55 kg (95% CI -5.80 to +0.02) in the 12 months postdiscontinuation. A greater number of years since HIV diagnosis was associated with greater reversibility of weight gain. No associations were found between weight change postdiscontinuation and changes in NRTI backbone or anchor agent at moment of discontinuation. CONCLUSION There was no evidence of rapid reversibility of at least 7% TAF-associated and/or INSTI-associated weight gain after discontinuation of these agents. Studies of larger and more diverse populations of PWH are required to more fully understand the degree to which weight gain is reversible when discontinuing TAF and/or INSTI.
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Affiliation(s)
- Myrthe L. Verburgh
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
- Division Infectious Diseases, Amsterdam Institute for Infection and Immunity
- Division Global Health, Amsterdam Public Health
- Amsterdam Institute for Global Health and Development
| | - Ferdinand W.N.M. Wit
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
- Division Infectious Diseases, Amsterdam Institute for Infection and Immunity
- HIV Monitoring Foundation
| | - Anders Boyd
- HIV Monitoring Foundation
- Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Peter Reiss
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
- Division Infectious Diseases, Amsterdam Institute for Infection and Immunity
- Division Global Health, Amsterdam Public Health
- Amsterdam Institute for Global Health and Development
- Global Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Marc Van der Valk
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
- Division Infectious Diseases, Amsterdam Institute for Infection and Immunity
- HIV Monitoring Foundation
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40
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Hachey D, van Woerden I, Shiluama R, Singu BS. Weight gain in Namibians with HIV switching from efavirenz to dolutegravir. Int J STD AIDS 2023; 34:854-859. [PMID: 37309139 DOI: 10.1177/09564624231179767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research suggests that integrase strand transferase inhibitor use can lead to weight gain, and data from sub-Saharan countries are limited. This study investigated changes in weight in Namibians switched from tenofovir DF/emtricitabine/efavirenz (TEE) to tenofovir DF/lamivudine/dolutegravir (TLD). METHODS Longitudinal, retrospective, and quantitative study from outpatient records of Namibians living with HIV/AIDS switched from efavirenz-to dolutegravir-based regimen at four clinics. A linear mixed effects model predicting weight 6 months prior to the switch, time of the switch, and at 6, 12-, and 18-months post-switch was run. A second analysis comparing change in weights between males and females was also run. RESULTS 242 patients switched from TEE to TLD. Compared to patient weight at the time of the switch, weights were significantly higher at 6 (+0.9 kg, p = 0.004), 12 (+1.7 kg, p < 0.001), and 18 months (+1.4 kg, p < 0.001) post-switch. There was no significant weight change for males, but females had a significant weight gain at 12 (+1.58 kg, p = 0.012) and 18 months (+1.49 kg, p = 0.024) post switch. CONCLUSIONS Females living with HIV in Namibia gain weight when switched from TEE to TLD. Clinical implications on the development of cardiometabolic complications is unclear and mechanisms by which the weight gain occurs are unknown.
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Affiliation(s)
- David Hachey
- Department of Family Medicine, Idaho State University, Pocatello, ID, United States
- Department of Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
| | - Irene van Woerden
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
| | - Roselli Shiluama
- Department of Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
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Webel AR, Davey CH, Oliveira V, Cleveland D, Crane HM, Gripshover BM, Long DM, Fleming JG, Buford TW, Willig AL. Physical activity is associated with adiposity in older adults with HIV in the modern HIV era. AIDS 2023; 37:1819-1826. [PMID: 37382891 PMCID: PMC10527629 DOI: 10.1097/qad.0000000000003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVES People with HIV (PWH) are aging and are experiencing higher rates of abdominal adiposity. Physical activity is an effective nonpharmacological strategy to reduce adiposity in the general aging population. Yet, the relationship between physical activity and adiposity in people with well controlled HIV is unclear. Our objective was to describe the association between objectively-measured physical activity and abdominal adiposity in PWH. METHODS As part of the multisite, observational PROSPER-HIV study, virologically suppressed, adult PWH wore an Actigraph accelerometer for 7-10 days and completed duplicate waist and hip circumference measures. Demographic and medical characteristics were abstracted from the CFAR Network of Integrated Clinical Systems dataset. Descriptive statistics and multiple linear regressions were used to analyze the data. RESULTS On average, our 419 PWH were 58 years of age [interquartile range (IQR): 50, 64], male (77%), Black (54%), and currently taking an integrase inhibitor (78%). PWH completed a mean of 7.06 (±2.74) days of total actigraphy wear time. They took an average of 4905 (3233, 7140) steps per day and engaged in 5.4 h of sedentary time per day. Controlling for age, sex, employment and integrase inhibitor use, the number of steps taken per day was associated with reduced abdominal adiposity ( F = 3.27; P < 0.001) and the hours of daily sedentary time was associated with increased abdominal adiposity ( F = 3.24; P < 0.001). CONCLUSIONS Greater physical activity is associated with reduced abdominal adiposity in aging PWH. Future work should investigate how to tailor the amount, type and intensity of physical activity needed to reduce adiposity in PWH taking contemporary HIV medication. REGISTRATION NUMBER NCT03790501.
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Affiliation(s)
- Allison R Webel
- University of Washington School of Nursing, Seattle, Washington
| | | | - Vitor Oliveira
- University of Washington School of Nursing, Seattle, Washington
| | - Dave Cleveland
- University of Alabama at Birmingham (UAB) Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama
| | - Heidi M Crane
- University of Washington School of Medicine, Seattle, Washington
| | | | - Dustin M Long
- The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Thomas W Buford
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Amanda L Willig
- The University of Alabama at Birmingham, Birmingham, Alabama
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Tse J, Prajapati G, Zhao X, Near AM, Kumar PN. Weight gain following switch to integrase inhibitors from non-nucleoside reverse transcriptase or protease inhibitors in people living with HIV in the United States: analyses of electronic medical records and prescription claims. Curr Med Res Opin 2023; 39:1237-1246. [PMID: 37480288 DOI: 10.1080/03007995.2023.2239661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES Real-world data evaluating weight changes in people living with HIV (PLWH) following switch to integrase strand transfer inhibitor (INSTI), specifically bictegravir (BIC), are limited. This retrospective cohort study analyzed weight changes upon switching to INSTI from non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) in treatment-experienced PLWH. METHODS Adult PLWH (≥18 years) treated with NNRTI or PI (non-switch cohorts) and those switching to INSTI (switch cohorts) between January 1, 2014 and August 31, 2019 were identified using IQVIA's Ambulatory Electronic Medical Records linked to a prescription drug claims database. The associations of switching to INSTI and individual INSTI agents with having ≥5% weight gain at 12 months of follow-up were evaluated, adjusting for demographics and baseline clinical characteristics. RESULTS At 12 months of follow-up, PLWH in the NNRTI-INSTI switch cohort (n = 508) were more likely to have ≥5% weight gain over 12 months compared to the NNRTI non-switch cohort (n = 614; odds ratio, OR [95% CI], 1.7 [1.2-2.4]). Switching from NNRTI to dolutegravir (DTG: OR [95% CI], 2.1 [1.4-3.0]) or BIC (2.0 [1.0-4.2]) resulted in significantly higher odds of ≥5% weight gain. PI-INSTI switch (n = 295) and non-switch (n = 228) cohorts had similar proportions of PLWH with ≥5% (21.1-23.4%) or ≥10% (7.8-7.9%) weight gain, and no significant association was found between switching from PI to INSTI and weight gain. CONCLUSION Weight gain and related metabolic health of PLWH switching from NNRTI to DTG or BIC should be closely monitored by clinicians. Further research is needed to assess other metabolic outcomes in PLWH remaining on PI and those who switch from PI to INSTI.
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Affiliation(s)
- Jenny Tse
- Real World Solutions, IQVIA, Durham, NC, USA
| | | | | | | | - Princy N Kumar
- Georgetown University Medical Center, Washington, DC, USA
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Batterham RL, Espinosa N, Katlama C, McKellar M, Scholten S, Smith DE, Ait-Khaled M, George N, Wright J, Gordon LA, Moodley R, Wynne B, van Wyk J. Cardiometabolic Parameters 3 Years After Switch to Dolutegravir/Lamivudine vs Maintenance of Tenofovir Alafenamide-Based Regimens. Open Forum Infect Dis 2023; 10:ofad359. [PMID: 37520420 PMCID: PMC10375426 DOI: 10.1093/ofid/ofad359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cardiometabolic outcomes were investigated 3 years after switching to the 2-drug regimen dolutegravir/lamivudine (DTG/3TC) vs continuing 3-/4-drug tenofovir alafenamide (TAF)-based regimens in a multicenter phase 3 noninferiority study based on an open-label randomized design. Method Adults with virologically suppressed HIV-1 switched to once-daily DTG/3TC (n = 369) or continued TAF-based regimens (n = 372). Cardiometabolic health parameters were assessed through week 144 via mixed-model repeated measures or logistic regression analyses, adjusting for baseline variables. Results At week 144, 13% (42/316) of the DTG/3TC group and 12% (37/303) of the TAF-based regimen group had ≥10% weight gain from baseline (adjusted odds ratio, 1.11; 95% CI, .68-1.80). Adjusted change from baseline in serum leptin, a surrogate marker of adiposity, was similar between groups (treatment ratio, 1.00; 95% CI, .89-1.13). The lipid profile generally favored DTG/3TC in the baseline boosted subgroup. Adjusted odds revealed no clinically meaningful differences between groups: homeostatic model assessment of insulin resistance ≥2 (adjusted odds ratio, 0.79; 95% CI, .50-1.26), metabolic syndrome (International Diabetes Federation criteria, 0.99; .59-1.68), hepatic fibrosis (fibrosis-4 index score ≥1.45, 1.39; .63-3.06), and coronary artery disease risk (Framingham risk score ≥10%, 0.92; .56-1.49). Baseline variables and characteristics associated with odds of each cardiometabolic parameter outcome were consistent with known risk factors, including age, sex, race, and some disease characteristics. Conclusions Cardiometabolic health 3 years after switching to DTG/3TC was comparable to that for individuals continuing TAF-based regimens, further supporting DTG/3TC as a robust switch option with a stable metabolic profile. Trial registration ClinicalTrials.gov NCT03446573.
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Affiliation(s)
- Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Nuria Espinosa
- Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | - Christine Katlama
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, INSERM–Sorbonne Universités, Paris, France
| | - Mehri McKellar
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
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Brenner BG, Oliveira M, Ibanescu RI, Routy JP, Thomas R. Doravirine responses to HIV-1 viruses bearing mutations to NRTIs and NNRTIs under in vitro selective drug pressure. J Antimicrob Chemother 2023:7193939. [PMID: 37303226 DOI: 10.1093/jac/dkad184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES The NNRTI doravirine has been recently approved for the first-line treatment of HIV-infected patients, eliciting favourable responses against viruses bearing the K103N, Y181C and G190A mutations. This study used in vitro drug selections to elaborate the breadth of doravirine responses against viruses bearing NNRTI and NRTI resistance-associated mutations (RAMs). METHODS WT clinical isolates (n = 6) and viruses harbouring common NRTI and NNRTI RAMs (n = 6) were serially passaged in escalating concentrations of doravirine, doravirine/islatravir, doravirine/lamivudine and rilpivirine over 24 weeks. Genotypic analysis ascertained the appearance and accumulation of NNRTI RAMs. Phenotypic drug susceptibility assays assessed resistance conferred by acquired NNRTI RAMs. RESULTS For WT viruses, doravirine pressure led to the appearance of V108I or V106A/I/M RAMs after 8 weeks, conferring low-level (∼2-fold) resistance. After 24 weeks, the accumulation of three to six secondary RAMs, including F227L, M230L, L234I and/or Y318, resulted in high-level (>100-fold) resistance to doravirine. Notably, viruses with these doravirine RAMs remained susceptible to rilpivirine and efavirenz. This contrasted with rilpivirine where acquisition of E138K, L100I and/or K101E resulted in >50-fold cross-resistance to all NNRTIs. Doravirine selection of viruses bearing common NRTI and NNRTI RAMs showed delayed acquisition of RAMs compared with WT virus. Pairing doravirine with islatravir or lamivudine attenuated the development of NNRTI RAMs. CONCLUSIONS Doravirine showed favourable resistance profiles against viruses harbouring NRTI and NNRTI RAMs. The high barrier to resistance to doravirine coupled with the long intracellular half-life of islatravir may provide the opportunity for long-acting treatment options.
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Affiliation(s)
- Bluma G Brenner
- McGill University AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Maureen Oliveira
- McGill University AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ruxandra-Ilinca Ibanescu
- McGill University AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Réjean Thomas
- Clinique médicale l'Actuel, Montreal, Quebec, Canada
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Sterman FL, Lalezari JP, Kowalczyk UM, Main DW, Grant EM, Caro L, Manning CM, Burke RL. Bictegravir/emtricitabine/tenofovir alafenamide plus doravirine in highly treatment-experienced men with multidrug-resistant HIV. AIDS 2023; 37:1057-1064. [PMID: 36927740 DOI: 10.1097/qad.0000000000003513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of switching highly treatment-experienced people with HIV (HTE PWH) from rilpivirine/emtricitabine/tenofovir alafenamide (RPV/FTC/TAF) plus dolutegravir (DTG) to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) plus doravirine (DOR). A pharmacokinetic (PK) analysis was conducted to assess the potential interaction between BIC and DOR. DESIGN AND METHODS This open-label switch trial enrolled HTE PWH from a primary care private practice in the United States. Eligible participants were male, aged ≥45 years, with documented viral resistance to protease inhibitors, nucleoside reverse transcriptase inhibitors, and/or nonnucleoside reverse transcriptase inhibitors but no resistance to RPV or DOR, and no K65R or T69 insertion mutations. Virologic suppression (≤50 copies/ml) while on RPV/FTC/TAF plus DTG for ≥6 months was required prior to enrollment. The primary endpoint of the study was virologic suppression (<50 and <200 copies/ml) at 48 weeks. Secondary endpoints included safety, tolerability, changes in body mass index (BMI), and identification of PK parameters of BIC and DOR. RESULTS Twenty males [median age: 65 years (range, 46-74), median time since HIV diagnosis: 37 years (range, 12-42)] completed the study. BIC/FTC/TAF plus DOR was well tolerated with no serious or treatment-related adverse events reported and no appreciable changes in BMI from baseline to Week 48. At Week 48, 100% of participants had <50 viral copies/ml. PK parameters for BIC and DOR ( n = 10) were consistent with published data. CONCLUSIONS Switching from RPV/FTC/TAF plus DTG to BIC/FTC/TAF plus DOR was well tolerated and efficacious in HTE men aged ≥45 years with HIV.
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Affiliation(s)
- Felicia L Sterman
- Gilead Sciences, Inc, Foster City
- Quest Clinical Research, San Francisco, California
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Guaraldi G, Bonfanti P, Di Biagio A, Gori A, Milić J, Saltini P, Segala FV, Squillace N, Taramasso L, Cingolani A. Evidence gaps on weight gain in people living with HIV: a scoping review to define a research agenda. BMC Infect Dis 2023; 23:230. [PMID: 37060030 PMCID: PMC10103467 DOI: 10.1186/s12879-023-08174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/17/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Combined antiretroviral therapy (cART) dramatically improved survival in people living with HIV (PLWH) but is associated with weight gain (WG), raising concern for a possible obesity epidemic in PLWH. This scoping review aims to identify the gaps in the existing evidence on WG in PLWH and generate a future research agenda. METHODS This review was conducted according to the methodology for scoping studies and reported according to the PRISMA Extension for Scoping Review checklist. Articles published in English in the last 10 years indexed in Pubmed, WHO Global Index Medicus, or Embase were searched using specific queries focused on WG in PLWH. RESULTS Following the selection process, 175 included articles were reviewed to search for the available evidence on four specific topics: (I) definition of WG in PLWH, (II) pathogenesis of WG in PLWH, (III) impact of ART on WG, (IV) correlation of WG with clinical outcomes. A summary of the data enabled us to identify gaps and clearly define the following research agenda: (I) develop a data-driven definition of WG in PLWH and define noninvasive assessment methods for body weight and fat composition; (II) further investigate the interaction between HIV/cART and immunity, metabolism, and adipose tissue; (III) establish the specific role of individual drugs on WG; (IV) clarify the independent role of WG, cART, HIV, and metabolic factors on clinical events. CONCLUSIONS The proposed research agenda may help define future research and fill the knowledge gaps that have emerged from this review.
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Affiliation(s)
- Giovanni Guaraldi
- HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Jovana Milić
- HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Saltini
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco V Segala
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Antonella Cingolani
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
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Changes in body mass index, weight, and waist-to-hip ratio over five years in HIV-positive individuals in the HIV Heart Aging Study compared to the general population. Infection 2023:10.1007/s15010-023-02009-8. [PMID: 36930373 DOI: 10.1007/s15010-023-02009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Overweight and obesity have increased in people living with HIV (PLH). Our study evaluated weight, body-mass-index (BMI), and waist-to-hip ratio (WHR) change over 5 years of follow-up in PLH compared to the general population. METHODS HIV-positive participants in the HIV Heart Aging (HIVH) study were matched 1:2 by age and sex with HIV-negative controls of the population-based Heinz Nixdorf Recall (HNR) study. Both studies were recruited in the German Ruhr area. The association between HIV and weight, BMI, and WHR changes was examined using linear regression. Regression models were adjusted for parameters potentially affecting weight gain. RESULTS The matched HIVH and HNR participants (N = 585 and N = 1170, respectively; 14.7% females) had a mean age of 55 years at baseline. Despite the lower baseline weight (- 6 kg, 95% CI - 7.46 to - 4.59), the linear regression showed greater absolute and relative weight and BMI increases after 5 years in HIVH compared to HNR. Adjusting the linear regression models for smoking amplified that HIVH had a higher absolute and relative weight difference of 0.7 kg or ~ 1% compared to HNR after 5 years (95% Cl 0.1 to 1.3 and 0.2 to 1.6, respectively). Adjusting for HDL, LDL, systolic blood pressure, and diabetes mellitus did not affect the results. CONCLUSIONS PLH had lower weight than the general population at baseline and after 5 years, but experienced greater increases in body weight after 5 years. WHR change after 5 years was lower in PLH compared to the general population, despite a higher WHR at baseline.
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Waters L, Assoumou L, González-Cordón A, Rusconi S, Domingo P, Gompels M, de Wit S, Raffi F, Stephan C, Masiá M, Rockstroh J, Katlama C, Behrens GMN, Moyle G, Johnson M, Fox J, Stellbrink HJ, Guaraldi G, Florence E, Esser S, Gatell JM, Pozniak A, Martínez E. Limited Weight Impact After Switching From Boosted Protease Inhibitors to Dolutegravir in Persons With Human Immunodeficiency Virus With High Cardiovascular Risk: A Post Hoc Analysis of the 96-Week NEAT-022 Randomized Trial. Clin Infect Dis 2023; 76:861-870. [PMID: 36259527 DOI: 10.1093/cid/ciac827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the NEAT022 trial, virologically suppressed persons with human immunodeficiency virus (HIV) at high cardiovascular risk switching from protease inhibitors to dolutegravir either immediately (DTG-I) or after 48 weeks (DTG-D) showed noninferior virological suppression and significant lipid and cardiovascular disease risk reductions on switching to dolutegravir relative to continuing protease inhibitors. METHODS In post hoc analysis, major endpoints were 48-week and 96-week weight and body mass index (BMI) changes. Factors associated with weight/BMI changes within the first 48 weeks of DTG exposure, proportion of participants by category of percentage weight change, proportions of BMI categories over time, and impact on metabolic outcomes were also assessed. RESULTS Between May 2014 and November 2015, 204 (DTG-I) and 208 (DTG-D) participants were included. Weight significantly increased (mean, +0.810 kg DTG-I arm, and +0.979 kg DTG-D arm) in the first 48 weeks postswitch, but remained stable from 48 to 96 weeks in DTG-I arm. Switching from darunavir, White race, total to high-density lipoprotein cholesterol ratio <3.7, and normal/underweight BMI were independently associated with higher weight/BMI gains. The proportion of participants with ≥5% weight change increased similarly in both arms over time. The proportions of BMI categories, use of lipid-lowering drugs, diabetes and/or use of antidiabetic agents, and hypertension and/or use of antihypertensive agents did not change within or between arms at 48 and 96 weeks. CONCLUSIONS Switching from protease inhibitors to dolutegravir in persons with HIV with high cardiovascular risk led to modest weight gain limited to the first 48 weeks, which involved preferentially normal-weight or underweight persons and was not associated with negative metabolic outcomes. CLINICAL TRIALS REGISTRATION NCT02098837 and EudraCT 2013-003704-39.
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Affiliation(s)
- Laura Waters
- Mortimer Market Centre, Central and North West London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Lambert Assoumou
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Ana González-Cordón
- Hospital Clínic, Consorci Institut D'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Stefano Rusconi
- Unità Operativa Malattie Infettive, Ospedale Civile di Legnano, Azienda Socio Sanitaria Territoriale Ovest Milanese, Legnano (MI), Italy
| | - Pere Domingo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Hospital de Sant Pau, Barcelona, Spain
| | - Mark Gompels
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Stephane de Wit
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - Christoph Stephan
- Universitätsklinikum, Goethe-University, Abteilung für Infektionskrankheiten, Frankfurt, Germany
| | - Mar Masiá
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Hospital General Universitario de Elche, Spain
| | | | | | | | - Graeme Moyle
- Chelsea and Westminster Hospital NHS Foundation Trust
| | | | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust/King's College, London, United Kingdom
| | | | | | - Eric Florence
- Instituut voor Tropische Geneeskunde, Antwerp, Belgium
| | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust
| | - Esteban Martínez
- Hospital Clínic, Consorci Institut D'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Abstract
PURPOSE OF REVIEW Weight gain has emerged as an important problem in people with HIV (PWH). When dealing with obesity, PWH face additional challenges to those without HIV. Understanding the nature of the problem and the modern evidence is essential to optimize management and identify knowledge gaps. RECENT FINDINGS Some PWH treated with antiretroviral therapy (ART) gain unhealthy amounts of weight and develop consequences of obesity. Newer agents have been consistently associated with excessive weight gain. Key studies are underway to inform the optimal use of specific ART in PWH dealing with obesity. For weight management, behavioral interventions fostering a healthier and active lifestyle, coupled with pharmacological therapies such as glucagon-like peptide 1 receptor agonists may be effective strategies in PWH, as recently demonstrated in those without HIV, although data in this regard is pending. SUMMARY A growing body of research has come to light in recent years regarding weight gain and obesity in PWH. However, much of the knowledge that inform current practices is extrapolated from studies in people without HIV. Modern ART regimens may promote excessive weight gain in some, and more research is needed to optimize ART selection and the use of weight loss medications.
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Affiliation(s)
- Luis Parra-Rodriguez
- Department of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA
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Avihingsanon A, Chetchotisakd P, Kiertiburanakul S, Ratanasuwan W, Siripassorn K, Supparatpinyo K, Martin H, Wang H, Wong T, Wang HY. Efficacy and safety of switching to bictegravir, emtricitabine, and tenofovir alafenamide in virologically suppressed Asian adults living with HIV: A pooled analysis from three international phase III randomized trials. HIV Med 2023; 24:290-300. [PMID: 36912172 DOI: 10.1111/hiv.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Data on switching to bictegravir, emtricitabine, and tenofovir alafenamide (B/F/TAF) in virologically suppressed Asian people living with HIV are limited. We performed a pooled analysis of virologically suppressed Asian participants from three international phase III trials to evaluate the efficacy and safety of switching to B/F/TAF. METHODS Virologically suppressed people living with HIV were randomized to switch to B/F/TAF or to stay on baseline regimens. The primary endpoint was the proportion of participants with plasma HIV-1 RNA ≥50 copies/ml at week 48. We analysed the incidence of adverse events (AEs), laboratory abnormalities, and changes in relevant tolerability parameters through 48 weeks. RESULTS Overall, 136 Asian participants were included. The proportions of participants with plasma HIV-1 RNA ≥50 copies/ml at week 48 were low in both arms (0% for B/F/TAF vs 1.4% for those who stayed on baseline regimens). Those who switched to B/F/TAF had virological suppression rates similar to those who stayed on baseline regimens (100% vs 95.9%, p = 0.2485), with no treatment-emergent resistance. Drug-related AEs occurred in three participants in each arm; none were serious. No participants discontinued the study drug because of AEs, and no deaths were observed. No significant differences were observed between the arms in the median changes in estimated glomerular filtration rate, body weight, and most lipid parameters. Switching from tenofovir disoproxil fumarate-containing regimens to B/F/TAF resulted in a significant decrease in tubular proteinuria compared with those who stayed on baseline regimens (p < 0.01). CONCLUSIONS Virologically suppressed Asian people living with HIV who switched to B/F/TAF maintained 100% virological suppression at week 48, with no treatment-emergent drug resistance and safety profiles comparable to those seen in people who stayed on baseline regimens. CLINICAL TRIAL NUMBER ClinicalTrials.gov (NCT02603120, NCT02652624, and NCT02603107).
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Affiliation(s)
- Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Centre of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Winai Ratanasuwan
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Hal Martin
- Gilead Sciences, Foster City, California, USA
| | - Hui Wang
- Gilead Sciences, Foster City, California, USA
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