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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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Abrams EJ, Jao J, Madlala HP, Zerbe A, Catalano P, Gerschenson M, Goedecke JH, Gomba Y, Josefson J, Kurland IJ, Legbedze J, McComsey GA, Matyesini S, Mukonda E, Robinson D, Myer L. An observational cohort study to investigate the impact of dolutegravir in pregnancy and its obesogenic effects on the metabolic health of women living with HIV and their children: Study protocol. PLoS One 2024; 19:e0307296. [PMID: 39159183 PMCID: PMC11332920 DOI: 10.1371/journal.pone.0307296] [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: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Dolutegravir (DTG)-based antiretroviral therapy is the World Health Organization's preferred first-line regimen for all persons with HIV, including pregnant women. While DTG has been implicated as an obesogen associated with greater weight gain compared to other antiretrovirals, there is a paucity of data in pregnant women and their children. The Obesogenic oRigins of maternal and Child metabolic health Involving Dolutegravir (ORCHID) study is investigating associations between DTG, weight gain, and metabolic outcomes in the context of HIV. MATERIALS & METHODS ORCHID is a prospective observational study taking place in Cape Town, South Africa (NCT04991402). A total of 1920 pregnant women with and without HIV infection are being followed from ≤18 weeks gestational age to 24 months postpartum with their children. Participants attend eleven study visits: 3 antenatal, delivery, and 7 postnatal visits. Several embedded sub-studies address specific scientific aims. Primary outcome measurements in mothers include anthropometry, blood pressure, body composition, dysglycemia, insulin resistance (IR), and dyslipidemia. Other maternal measures include demographics, resting energy expenditure, viral load, physical activity, dietary intake, hepatic steatosis, and repository specimens. Sub-study measurements include markers of adipose inflammation, gut integrity, and satiety/hunger, subcutaneous adipose tissue morphology and mitochondrial function, and metabolomics. Primary outcome measurements in children include anthropometry, adipose tissue mass, dysglycemia, IR, and dyslipidemia. Other variables include fetal growth, birth outcomes, medical/breastfeeding history, caloric intake, neurodevelopment, and repository specimens. Sub-study measurements include metabolites/lipid subspecies in umbilical cord blood, as well as breast milk composition and DTG exposure. DISCUSSION ORCHID will play a pivotal role in defining obesogenic mechanisms and clinical consequences of DTG use in pregnancy in women with HIV and their children. It will provide insights into metabolic disease risk reduction in the context of HIV/DTG, identify intervention targets, and inform public health approaches to diminish chronic metabolic co-morbidities for women and children.
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Affiliation(s)
- Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States of America
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Hlengiwe P. Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, United States of America
| | - Mariana Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States of America
| | - Julia H. Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Division of Physiological Sciences, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Yolanda Gomba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Jami Josefson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Irwin J. Kurland
- Department of Medicine, Stable Isotope and Metabolomics Core Facility, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Justine Legbedze
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Grace A. McComsey
- University Hospitals Health System, Cleveland, OH, United States of America
- Department of Medicine and Pediatrics of Case Western Reserve University, Cleveland, OH, United States of America
| | - Sandisiwe Matyesini
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Daniel Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
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Madlala HP, Myer L, Jao J, Geffen H, Matjila M, Fisher A, Meyer D, Werner EF, Petro G, Cu‐Uvin S, McGarvey ST, Bengtson AM. Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study. J Int AIDS Soc 2024; 27:e26313. [PMID: 38926935 PMCID: PMC11208166 DOI: 10.1002/jia2.26313] [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: 02/12/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes. METHODS We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression. RESULTS Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01). CONCLUSIONS Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.
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Affiliation(s)
- Hlengiwe P. Madlala
- Division of Epidemiology and BiostatisticsSchool of Public Health, University of Cape TownCape TownSouth Africa
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health, University of Cape TownCape TownSouth Africa
| | - Jennifer Jao
- Division of Infectious Diseases, Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of Infectious Diseases, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Hayli Geffen
- Division of Epidemiology and BiostatisticsSchool of Public Health, University of Cape TownCape TownSouth Africa
| | - Mushi Matjila
- Department of Obstetrics & GynaecologyUniversity of Cape Town, Groote Schuur and New Somerset HospitalsCape TownSouth Africa
| | - Azetta Fisher
- Division of Epidemiology and BiostatisticsSchool of Public Health, University of Cape TownCape TownSouth Africa
| | - Demi Meyer
- Division of Epidemiology and BiostatisticsSchool of Public Health, University of Cape TownCape TownSouth Africa
| | - Erika F. Werner
- Department of Obstetrics and GynaecologySchool of Medicine, Tufts UniversityBostonMassachusettsUSA
| | - Gregory Petro
- Department of Obstetrics & GynaecologyUniversity of Cape Town, Groote Schuur and New Somerset HospitalsCape TownSouth Africa
| | - Susan Cu‐Uvin
- Department of Obstetrics and Gynaecology and MedicineWarren Alpert School of Medicine, Brown UniversityProvidenceRhode IslandUSA
| | - Stephen T. McGarvey
- Department of Epidemiology and International Health InstituteSchool of Public Health, Brown UniversityProvidenceRhode IslandUSA
| | - Angela M. Bengtson
- Department of EpidemiologyRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
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Hill SV, Hao J, Newlin-Bradner M, Long DM, Budhwani H, Simpson T. Re-evaluating the relationship between youth with HIV and BMI in an age of increasing rates of overweight and obese youth. BMC Res Notes 2024; 17:97. [PMID: 38561785 PMCID: PMC10983650 DOI: 10.1186/s13104-024-06741-8] [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: 06/29/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Newer antiretrivirals (ART) have shifted the metabolic experiences of people with HIV (PWH) from those of wasting syndrome to increases in body mass index (BMI). This study sought to examine the relationship between BMI and ART use among youth with HIV (YWH). METHODS Charts from YWH ages 10-24 with at least two documented BMIs at least 6 months apart between 2017 and 2020 were included (N = 44). Statistical analyses were conducted in SAS 9.4. RESULTS Clients were predominately African American (66%) males (73%) aged 19-24 years (64%), with men having sex with men (48%) being the most common mode of transmission. YWH on non-integrase inhibitor (INSTI) regimens had greater absolute increases in BMI compared to those on INSTI regimens (p = 0.03). Fourteen percent of clients using INSTI experienced an increase in BMI class from normal to overweight or overweight to obese; no non-INSTI users changed BMI class. Time since diagnosis and BMI change due to weight gain were positively associated (p = 0.03) among behaviorally-acquired YWH. CONCLUSIONS Increasing BMI and changing BMI classes may be more likely among YWH using INSTI. More longitudinal studies inclusive of diet and exercise profiles are needed to understand the relationship between INSTI and YWH BMI.
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Affiliation(s)
| | - Jiaying Hao
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Dustin M Long
- University of Alabama at Birmingham, Birmingham, AL, USA
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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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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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Nissim OA, Haney A, Lazenby GB. Effect of tenofovir alafenamide in combination with and without integrase inhibitors on weight gain, diabetes, and hypertensive disorders of pregnancy. Pregnancy Hypertens 2023; 34:47-52. [PMID: 37804587 DOI: 10.1016/j.preghy.2023.09.008] [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: 11/18/2022] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES We sought to determine if tenofovir alafenamide (TAF) was associated with excessive weight gain, diabetes (DM), and hypertensive disorders of pregnancy (HDP) in persons with HIV. STUDY DESIGN This is a retrospective cohort study of pregnant persons with HIV prescribed antiretroviral therapy (ART) during the period of 01/01/2009 to 12/31/2020. MAIN OUTCOMES MEASURES χ2 tests were used to compare the proportion of persons with excessive weight gain, DM, and HDP according to ART regimens. Excess total gestational weight gain was calculated using BMI and Institute of Medicine recommendations for weight gain in pregnancy. HDP included gestational hypertension and preeclampsia. Logistic regression models were used to determine predictors of excessive weight gain, DM, and HDP. RESULTS We identified 189 pregnant persons prescribed ART with (30) and without TAF (159). The percentage of persons with excessive gestational weight gain was not significantly different in persons prescribed TAF (32 %) and other ART (17 %), p = 0.2. Persons prescribed TAF were more likely to have HDP (30 %) compared to other ART (9 %), p = 0.001. In the adjusted analysis, DM [aOR 6.2 (95 % CI 1.2-32.7)] and TAF exposure [aOR 3.2 (95 % CI 1.0-8.9)] were significantly associated with HDP. CONCLUSION Despite similar gestational weight gain, persons with HIV prescribed TAF were more likely to have HDP. Further understanding of the metabolic and cardiovascular impact of ART recommended for use during pregnancy is needed.
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Affiliation(s)
- Oriel A Nissim
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Ashley Haney
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Gweneth Bratton Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
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Lahiri CD, Mehta CC, Sykes C, Weiser SD, Palella F, Lake JE, Mellors JW, Gustafson D, French AL, Adimora AA, Konkle-Parker D, Sharma A, Bolivar H, Kassaye SG, Rubin LH, Alvarez JA, Golub ET, Ofotokun I, Sheth AN. Obesity Modifies the Relationship Between Raltegravir and Dolutegravir Hair Concentrations and Body Weight Gain in Women Living with HIV. AIDS Res Hum Retroviruses 2023; 39:644-651. [PMID: 37140468 PMCID: PMC10712367 DOI: 10.1089/aid.2022.0185] [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: 05/05/2023] Open
Abstract
Integrase strand-transfer inhibitors (INSTIs) are associated with weight gain in women living with HIV (WLH). Relationships between drug exposure, baseline obesity, and INSTI-associated weight gain remain unclear. Data from 2006 to 2016 were analyzed from virally suppressed WLH enrolled in the Women's Interagency HIV Study, who switched/added an INSTI to antiretroviral therapy: [raltegravir (RAL), dolutegravir (DTG), or elvitegravir (EVG)]. Percent body weight change was calculated from weights obtained a median 6 months pre-INSTI and 14 months post-INSTI initiation. Hair concentrations were measured with validated liquid chromatography-mass spectrometry (MS)/MS assays. Baseline (preswitch) weight status evaluated obese (body mass index, BMI, ≥30 kg/m2) versus nonobese (BMI <30 kg/m2). Mixed models examined the drug hair concentration*baseline obesity status interaction for each INSTI. There were 169 WLH included: 53 (31%) switched to RAL, 72 (43%) to DTG, and 44 (26%) to EVG. Women were median age 47-52 years, predominantly Non-Hispanic Black, median CD4 counts >500 cells/mm3, >75% with undetectable HIV-1 RNA. Over ∼1 year, women experienced median increases in body weight: 1.71% (-1.78, 5.00) with RAL; 2.40% (-2.82, 6.50) with EVG; and 2.48% (-3.60, 7.88) with DTG. Baseline obesity status modified the relationship between hair concentrations and percent weight change for DTG and RAL (p's < 0.05): higher DTG, yet lower RAL concentrations were associated with greater weight gain among nonobese women. Additional pharmacologic assessments are needed to understand the role of drug exposure in INSTI-associated weight gain.
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Affiliation(s)
- Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Craig Sykes
- Clinical Pharmacology and Analytical Chemistry Core, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Frank Palella
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jordan E. Lake
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John W. Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center/Stroger (Cook County) Hospital, Chicago, Illinois, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Health System, Miami, Florida, USA
| | - Seble G. Kassaye
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Leah H. Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, and Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Stenberg E, Carlander C, Cao Y, Ottosson J, Näslund E. Metabolic and Bariatric Surgery for People Living With HIV-A Propensity-Matched Cohort Study. J Acquir Immune Defic Syndr 2023; 94:e5-e8. [PMID: 37850984 DOI: 10.1097/qai.0000000000003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christina Carlander
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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De Clercq E, Zhang Z, Huang J, Zhang M, Li G. Biktarvy for the treatment of HIV infection: Progress and prospects. Biochem Pharmacol 2023; 217:115862. [PMID: 37858869 DOI: 10.1016/j.bcp.2023.115862] [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: 08/30/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Bictegravir (BIC), a second-generation integrase strand-transfer inhibitor (INSTI) with high resilience to INSTI-resistance mutations, is integrated as a key component of Biktarvy® - a fixed-dose once-daily triple-drug regimen of bictegravir (BIC), emtricitabine (FTC) plus tenofovir alafenamide (TAF). Based on the accumulated evidence from HIV clinical trials and real-world studies, the clinical effectiveness of BIC + FTC + TAF has been proven non-inferior to other fixed-dose once-daily combinations such as dolutegravir + FTC + TAF and dolutegravir + abacavir + lamivudine. Biktarvy also shows limited drug-drug interactions and a high barrier to drug resistance. According to recent HIV guidelines, BIC + FTC + TAF is recommended as initial and long-term therapy for the treatment of HIV infection. For the pre-exposure prophylaxis, tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) remains advisable, but BIC may be possibly added to TDF or TAF. In the development of a long-acting once-monthly regimen, the novel nano-formulation of BIC + FTC + TAF could be possibly developed in the future.
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Affiliation(s)
- Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven 3000, Belgium
| | - Zhenlan Zhang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410013, China
| | - Jie Huang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410013, China
| | - Min Zhang
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Guangdi Li
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410013, China; FuRong Laboratory, Changsha 410078, China.
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Rein SM, Lodi S, Logan RW, Touloumi G, Antoniadou A, Wittkop L, Bonnet F, van Sighem A, van der Valk M, Reiss P, Klein MB, Young J, Jarrin I, d'Arminio Monforte A, Tavelli A, Meyer L, Tran L, Gill MJ, Lang R, Surial B, Haas AD, Justice AC, Rentsch CT, Phillips A, Sabin CA, Miro JM, Trickey A, Ingle SM, Sterne JAC, Hernán MA. Integrase strand-transfer inhibitor use and cardiovascular events in adults with HIV: an emulation of target trials in the HIV-CAUSAL Collaboration and the Antiretroviral Therapy Cohort Collaboration. Lancet HIV 2023; 10:e723-e732. [PMID: 37923486 PMCID: PMC10695103 DOI: 10.1016/s2352-3018(23)00233-3] [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: 05/09/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A recent observational study suggested that the risk of cardiovascular events could be higher among antiretroviral therapy (ART)-naive individuals with HIV who receive integrase strand-transfer inhibitor (INSTI)-based ART than among those who receive other ART regimens. We aimed to emulate target trials separately in ART-naive and ART-experienced individuals with HIV to examine the effect of using INSTI-based regimens versus other ART regimens on the 4-year risk of cardiovascular events. METHODS We used routinely recorded clinical data from 12 cohorts that collected information on cardiovascular events, BMI, and blood pressure from two international consortia of cohorts of people with HIV from Europe and North America. For the target trial in individuals who had previously never used ART (ie, ART-naive), eligibility criteria were aged 18 years or older, a detectable HIV-RNA measurement while ART-naive (>50 copies per mL), and no history of a cardiovascular event or cancer. Eligibility criteria for the target trial in those with previous use of non-INSTI-based ART (ie, ART-experienced) were the same except that individuals had to have been on at least one non-INSTI-based ART regimen and be virally suppressed (≤50 copies per mL). We assessed eligibility for both trials for each person-month between January, 2013, and January, 2023, and assigned individuals to the treatment strategy that was compatible with their data. We estimated the standardised 4-year risks of cardiovascular events (myocardial infarction, stroke, or invasive cardiovascular procedure) via pooled logistic regression models adjusting for time and baseline covariates. In per-protocol analyses, we censored individuals if they deviated from their assigned treatment strategy for more than 2 months and weighted uncensored individuals by the inverse of their time-varying probability of remaining uncensored. The denominator of the weight was estimated via a pooled logistic model that included baseline and time-varying covariates. FINDINGS The analysis in ART-naive individuals included 10 767 INSTI initiators and 8292 non-initiators of INSTI. There were 43 cardiovascular events in INSTI initiators (median follow-up of 29 months; IQR 15-45) and 52 in non-initiators (39 months; 18-47): standardised 4-year risks were 0·76% (95% CI 0·51 to 1·04) in INSTI initiators and 0·75% (0·54 to 0·98) in non-INSTI initiators; risk ratio 1·01 (0·57 to 1·57); risk difference 0·0089% (-0·43 to 0·36). The analysis in ART-experienced individuals included 7875 INSTI initiators and 373 965 non-initiators. There were 56 events in INSTI initiators (median follow-up 18 months; IQR 9-29) and 3103 events (808 unique) in non-INSTI initiators (26 months; 15-37) in non-initiators: standardised 4-year risks 1·41% (95% CI 0·88 to 2·03) in INSTI initiators and 1·48% (1·28 to 1·71) in non-initiators; risk ratio 0·95 (0·60 to 1·36); risk difference -0·068% (-0·60 to 0·52). INTERPRETATION We estimated that INSTI use did not result in a clinically meaningful increase of cardiovascular events in ART-naive and ART-experienced individuals with HIV. FUNDING National Institute of Allergy and Infectious Diseases and National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Sara Lodi
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Roger W Logan
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; SISTM, INRIA, Talence, France; CHU de Bordeaux, Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, France
| | - Fabrice Bonnet
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux, Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, France
| | | | - Marc van der Valk
- Stichting HIV Monitoring, Amsterdam, Netherlands; Amsterdam UMC, Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Peter Reiss
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - James Young
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Inmaculada Jarrin
- Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Laurence Meyer
- INSERM U1018, Université Paris Saclay, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Service de Santé Publique, Hôpital Bicêtr, Le Kremlin-Bicêtre, France
| | - Laurent Tran
- INSERM U1018, Université Paris Saclay, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre, France
| | - Michael J Gill
- Southern Alberta Clinic and Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raynell Lang
- Southern Alberta Clinic and Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas D Haas
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Health Policy, Yale School of Public Health, Yale University, New Haven, CT, USA; VA Connecticut Healthcare System, US Department of Veterans Affairs, New Haven, Connecticut, USA
| | - Christopher T Rentsch
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; VA Connecticut Healthcare System, US Department of Veterans Affairs, New Haven, Connecticut, USA; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Phillips
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Miguel A Hernán
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
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12
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Castle AC, Hoeppner SS, Manne-Goehler JM, Olivier S, Magodoro IM, Singh U, Edwards JA, Tanser F, Bassett IV, Wong EB, Siedner MJ. Identifying sex-specific anthropometric measures and thresholds for dysglycemia screening in an HIV-endemic rural South African population. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001698. [PMID: 37889883 PMCID: PMC10610455 DOI: 10.1371/journal.pgph.0001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Valid screening and diagnostic algorithms are needed to achieve 2030 targets proposed by the WHO's Global Diabetes Compact. We explored anthropometric thresholds to optimally screen and refer individuals for diabetes testing in rural South Africa. We evaluated screening thresholds for waist circumference (WC), body mass index (BMI), and waist-hip ratio (WHR) to detect dysglycemia based on a glycated hemoglobin (HbA1C) ≥6.5% among adults in a population-based study in South Africa using weighted, non-parametric ROC regression analyses. We then assessed the diagnostic validity of traditional obesity thresholds, explored optimal thresholds for this population, and fit models stratified by sex, age, and HIV status. The prevalence of dysglycemia in the total study population (n = 17,846) was 7.7%. WC had greater discriminatory capacity than WHR to detect dysglycemia in men (p-value<0.001) and women (p<0.001). WC had greater discriminatory capacity than BMI to detect dysglycemia in women (p<0.001). However, BMI and WC performed similarly for men (p = 0.589). Whereas traditional WC thresholds for women (>81cm) performed well (sensitivity 91%, positive predictive value [PPV] 14.9%), substantially lower thresholds were needed to achieve acceptable sensitivity and PPV among men (traditional >94cm, derived >79.5cm). WC outperforms BMI as an anthropometric screening measure for dysglycemia in rural South Africa. Whereas WC guideline thresholds are appropriate for women, male-derived WC cutoffs performed better at lower thresholds. In this rural South African population, thresholds that maximize specificity and PPV for efficient resource allocation may be preferred.
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Affiliation(s)
- Alison C. Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Jennifer M. Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Itai M. Magodoro
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Johnathan A. Edwards
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, United States of America
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
- Lincoln Institute for Health, University of Lincoln, Lincoln, United Kingdom
| | - Ingrid V. Bassett
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Emily B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, Alabama, United States of America
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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13
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Pérez-Barragán E, Guevara-Maldonado MF, Mancilla-Galindo J, Kammar-García A, Ortiz-Hernández A, Mata-Marín JA, Pérez-Cavazos S. Weight Gain After 12 Months of Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed HIV Patients. AIDS Res Hum Retroviruses 2023; 39:511-517. [PMID: 37071218 DOI: 10.1089/aid.2022.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Recent studies suggest that the introduction of antiretroviral agents such as integrase strand transfer inhibitors (INSTI) may lead to weight gain in people living with HIV (PLHIV). In this retrospective observational study, we report the weight changes observed in virologically suppressed HIV patients after 12 months of switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) due to a national change in public policy in Mexico. Patients on prior regimens based on TDF/FTC or ABC/3TC plus non-nucleoside retrotranscriptase inhibitor, INSTI, or protease inhibitor were included. In the 399 patients analyzed, a significant weight increase was found, as well as an increase in body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, creatinine, and CD4+ cells after 12 months of switching treatment (all p ≤ .001). Mean weight gain was 1.63 kg [confidence interval (95% CI): 1.14-2.11], whereas the average percentage of weight gained was 2.5% (95% CI: 1.83-3.17). After considering the confounding effect of baseline weight status, the change in weight and BMI did not present significant differences between any of the prior treatment schemes. In conclusion, PLHIV switching to BIC/F/TAF therapy experienced weight gain after the first year of switching treatment. Although this weight gain could be due to the switch in treatment regimen, it cannot be excluded that it was caused by other factors since no comparable control group could be used for comparison.
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Affiliation(s)
- Edgar Pérez-Barragán
- Servicio de Infectología, Hospital General de Zona N° 48, Ciudad de México, México
| | | | - Javier Mancilla-Galindo
- División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Ciudad de México, México
| | | | - José Antonio Mata-Marín
- Servicio de Infectología, Hospital de Infectología, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Samantha Pérez-Cavazos
- Departamento de Epidemiología Hospitalaria/Servicio de Infectología, Hospital Christus Muguerza Betania, Puebla, México
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14
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Palich R, Hentzien M, Hocqueloux L, Duvivier C, Allavena C, Huleux T, Makinson A, Rey D, Delobel P, Cuzin L. Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France. AIDS 2023; 37:1891-1896. [PMID: 37451430 DOI: 10.1097/qad.0000000000003657] [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: 07/18/2023]
Abstract
OBJECTIVES We aimed to examine the association of the country of birth and the other patients' characteristics with the prescription of two-drug regimens (2DRs) in virally suppressed people with HIV (PWH) in France. DESIGN Observational study conducted from the national Dat'AIDS prospectively collected database. METHODS We included all adults who were actively in care on 31 December 2020 in 26 French centers, with an HIV plasma viral load (pVL) <50 copies/ml for at least 6 months while on antiretroviral therapy (ART). Patients with chronic hepatitis B were excluded because they are not eligible to 2DRs. Univariate and multivariate logistic regressions were built to analyze relationships between patients' characteristics and receiving a 2DR. RESULTS We analyzed data from 28 395 PWH: 41.7% men who have sex with men, 31.7% women and 26.5% heterosexual men; 35% born abroad. Median age was 53 years [interquartile range (IQR) 44-60]; ART duration 14 years (8-23); duration of virological suppression 87 months (42-142). 2DRs (mainly dolutegravir/rilpivirine, 53.8%, or dolutegravir/lamivudine, 41.7%) were prescribed in 16.3% of the patients and were less common in the 'born abroad' group (18.9% versus 11.5%). The multivariate model showed that individuals born in France were more likely to receive a 2DR [adjusted odds ratio (aOR): 1.62 [1.50-1.74]], independently of other characteristics. Older PLWH and those with higher CD4 + T-cell counts were also more likely to receive a 2DR. CONCLUSION Despite unrestricted access to ART in France, independently from HIV disease parameters, PWH born abroad were less likely to receive 2DRs as a maintenance regimen than those born in France. Qualitative data are needed to better understand physicians' prescribing practices.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris
| | - Maxime Hentzien
- Infectious Diseases, Internal Medicine and Clinical Immunology Department, Centre Hospitalier Universitaire Robert Debré, Reims
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center; University Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine, Institut Pasteur, Institut Pasteur Medical Center, Paris
| | | | - Thomas Huleux
- Infectious and Travel Diseases Department, Tourcoing University Hospital, Tourcoing
| | - Alain Makinson
- University of Montpellier, Infectious Diseases and Tropical department, University Hospital Montpellier, Montpellier
| | - David Rey
- HIV Infection Care Center, Strasbourg University Hospital, Strasbourg
| | - Pierre Delobel
- University of Toulouse Paul Sabatier, Infectious and Tropical Diseases Department, Toulouse University Hospital, Toulouse
| | - Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France; Martinique University Hospital, Infectious and Tropical Diseases, Fort de France, France
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15
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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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Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany-Moretlwe S, Taiwo B, Masters MC, Lazarus JV. HIV infection. Nat Rev Dis Primers 2023; 9:42. [PMID: 37591865 DOI: 10.1038/s41572-023-00452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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17
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Donga P, Emond B, Rossi C, Bookhart BK, Lee J, Caron-Lapointe G, Wei F, Lafeuille MH. Weight and BMI Changes Following Initiation of Emtricitabine/Tenofovir Alafenamide Co-Formulated with Darunavir or Co-Administered with Dolutegravir in Overweight or Obese, ART-Naïve People Living with HIV-1. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:579-591. [PMID: 37521004 PMCID: PMC10377594 DOI: 10.2147/ceor.s413800] [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: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Integrase strand transfer inhibitor-based regimens (eg, containing dolutegravir [DTG]) are associated with weight/body mass index (BMI) increases among people living with HIV-1 (PLWH). Assessing antiretroviral therapy (ART)-related weight/BMI changes is challenging, as PLWH may experience return-to-health weight gain as a result of viral suppression. This retrospective, longitudinal real-world study compared weight/BMI outcomes among overweight/obese (BMI ≥25 kg/m2; thus excluding return-to-health weight/BMI changes), treatment-naïve PLWH who initiated darunavir (DRV)/cobicistat (c)/emtricitabine (FTC)/tenofovir alafenamide (TAF) or DTG + FTC/TAF. Methods Treatment-naïve PLWH with BMI ≥25 kg/m2 who initiated DRV/c/FTC/TAF or DTG + FTC/TAF (index date) had ≥12 months of baseline observation and ≥1 weight/BMI measurement in baseline and post-index periods in the Symphony Health IDV® database (07/17/2017-12/31/2021) were included. Inverse probability of treatment weighting (IPTW) was used to balance differences in baseline characteristics between cohorts. On-treatment time-to-weight/BMI increases ≥5% were compared between cohorts using weighted adjusted Cox models. Results Post-IPTW, 76 overweight/obese DRV/c/FTC/TAF-treated (mean age = 51.2 years, 30.7% female, 35.6% Black, mean baseline BMI = 33.2 kg/m2) and 88 overweight/obese DTG + FTC/TAF-treated PLWH (mean age = 51.5 years, 31.4% female, 31.4% Black, mean baseline BMI = 32.7 kg/m2) were included. The median [interquartile range] time from ART initiation to weight/BMI increase ≥5% was shorter for the DTG + FTC/TAF cohort (21.8 [9.9, 32.3] months) than the DRV/c/FTC/TAF cohort (median and interquartile times not reached; Kaplan-Meier rate at 21.8 months = 20.8%). Over the entire follow-up, overweight/obese PLWH initiating DTG + FTC/TAF had a more than twofold greater risk of experiencing weight/BMI increase ≥5% compared to those initiating DRV/c/FTC/TAF (hazard ratio [95% confidence interval]=2.43 [1.02; 7.04]; p = 0.036). Conclusion Overweight/obese PLWH who initiated DTG + FTC/TAF had significantly greater risk of weight/BMI increase ≥5% compared to similar PLWH who initiated DRV/c/FTC/TAF and had shorter time-to-weight/BMI increase ≥5%, suggesting a need for additional monitoring to assess the risk of weight gain-related cardiometabolic disease.
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Affiliation(s)
- Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | | | - Johnnie Lee
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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18
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Palich R, Hentzien M, Hocqueloux L, Duvivier C, Allavena C, Huleux T, Delobel P, Makinson A, Rey D, Cuzin L. Country of birth is associated with antiretroviral therapy choice in treatment-naive persons with HIV in France. AIDS 2023; 37:1459-1466. [PMID: 37115905 DOI: 10.1097/qad.0000000000003588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVES We aimed to describe factors associated with the choice of first antiretroviral therapy (ART) in persons with HIV (PWH) in France, included the country of birth, as well as the time to undetectable viral load and treatment discontinuation. DESIGN Observational study conducted from the national Dat'AIDS prospectively collected database. METHODS We included all adults who started their first ART between 01 January 2014 and 31 December 2020, with a pretherapeutic plasma viral load (pVL) at least 400 copies/ml. Univariable and multivariable logistic regressions were used to analyze PWH characteristics driving to an integrase strand transfer inhibitors (INSTI)-based first prescribed regimen. We also analyzed time to first line discontinuation, and to a first undetectable pVL, using Kaplan-Meier model. RESULTS We analyzed data from 9094 PWH: 45% MSM, 27% women and 27% heterosexual men; 48% born abroad; 4.7 and 2.8% with concomitant hepatitis B and tuberculosis, respectively. INSTIs were prescribed as first-line therapy in 50% of PWH, which increased over time. Native French PWH were more likely to receive an INSTI-based regimen than PWH born abroad [adjusted prevalence ratio 1.47, 95% confidence interval (CI) 1.33-1.60], as were high pVL at diagnosis, hepatitis B or concomitant tuberculosis. Time before discontinuation of the first ART and reaching a first undetectable pVL was not different according to the place of birth. CONCLUSION Despite unrestricted access to INSTIs in France, independently from HIV disease parameters, PWH born abroad received INSTIs less frequently as a first regimen than those born in France. Qualitative data are needed to better understand physicians' prescribing practices.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière hospital, AP-HP, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM U1136, Paris
| | - Maxime Hentzien
- Infectious Diseases, Internal Medicine and Clinical Immunology Department, Centre Hospitalier Universitaire Robert Debré, Reims
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center, University Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, IHU Imagine, Institut Pasteur, Institut Pasteur Medical Center, Paris
| | | | - Thomas Huleux
- Infectious and Travel Diseases Department, Tourcoing University Hospital, Tourcoing
| | - Pierre Delobel
- Infectious and Tropical Diseases Department, Toulouse University Hospital, INSERM U1291, University of Toulouse Paul Sabatier, Toulouse
| | - Alain Makinson
- Infectious Diseases Department, University Hospital Montpellier, INSERM U1175, University of Montpellier, Montpellier
| | - David Rey
- HIV Infection Care Center, Strasbourg University Hospital, Strasbourg
| | - Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France, Martinique University Hospital, Infectious and Tropical Diseases, Fort de France, France
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Van Praet JT, Serrien B, Ausselet N, Darcis G, Demeester R, De Munter P, De Scheerder MA, Goffard JC, Libois A, Messiaen P, Yombi JC, Van Beckhoven D. Dynamics of Weight Change After Initiation of Contemporaneous Antiretroviral Therapy in Treatment-Naive HIV-1 Infected Patients: Results From the Belgian HIV Cohort 2015-2021. J Acquir Immune Defic Syndr 2023; 93:e4-e5. [PMID: 36787727 DOI: 10.1097/qai.0000000000003175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Jens T Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ben Serrien
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Gilles Darcis
- Department of Infectious Diseases and General Internal Medicine, University Hospital of Liège, Liège, Belgium
| | - Rémy Demeester
- HIV Reference Centre, University Hospital of Charleroi, Lodelinsart, Belgium
| | - Paul De Munter
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of General Internal Medicine, UZ Leuven, Leuven, Belgium
| | | | - Jean-Christophe Goffard
- HIV Reference Centre, Internal Medicine, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Libois
- Department of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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20
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Hickey MD, Wafula E, Ogachi SM, Ojwando H, Orori G, Adede RO, Garraza LG, Petersen ML, Havlir DV, Balzer LB, Ayieko J. Weight Change Following Switch to Dolutegravir for HIV Treatment in Rural Kenya During Country Roll-Out. J Acquir Immune Defic Syndr 2023; 93:154-161. [PMID: 36787723 PMCID: PMC10293078 DOI: 10.1097/qai.0000000000003173] [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: 11/21/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Switch to dolutegravir (DTG) in treatment-experienced people living with HIV (PLH) is associated with excess weight gain in some settings; data are limited from rural low-income settings with low obesity prevalence. METHODS In rural Kenya, we conducted a retrospective cohort study at 8 HIV clinics and a single-site prospective cohort study including adults switching to DTG during countrywide transition to DTG/tenofovir DF(TDF)/emtricitabine as first-line HIV treatment. In the retrospective analysis, we used preswitch data to model postswitch weight trajectory had each participant not switched to DTG and contrasted observed vs. predicted postswitch weight. In the prospective analysis, we measured weight post-DTG switch and evaluated predictors of 6-month weight change. RESULTS Our retrospective cohort included 4445 PLH who switched to DTG between 2018 and 2020. Mean 12-month weight change was 0.6 kg preswitch and 0.8 kg postswitch. Among those on TDF throughout (n = 3374; 83% on efavirenz preswitch), 12-month postswitch weight was 0.7 kg more than predicted for women (95% CI: 0.4, 1.0) and similar among men (0.04 kg; 95% CI -0.3, 0.4). In our prospective cohort (n = 135, 100% female), mean 6-month weight change was +0.4 kg (IQR -1.1, 2.0 kg). Predicted gain varied by baseline food insecurity: +1.1 kg (95% CI: 0.34, 1.87) among food secure, -0.09 kg (95% CI -0.71, 0.54) among moderate insecure, and +0.27 kg (95% CI -0.82, 1.36) among severe insecurity. CONCLUSION In contrast to some reports of large weight gain following switch to DTG, we observed small weight increases in women and no weight change in men following DTG switch when on TDF throughout. Weight gain may be attenuated by food insecurity, though was modest even among food secure.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States
| | - Erick Wafula
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Gordon Orori
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Maya L. Petersen
- School of Public Health, University of California, Berkeley, CA, United States
| | - Diane V. Havlir
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States
| | - Laura B. Balzer
- School of Public Health, University of California, Berkeley, CA, United States
| | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
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21
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Gardner AR, Ma Y, Bacchetti P, Price JC, Kuniholm MH, French AL, Gange S, Adimora AA, Minkoff H, Kassaye S, Ofotokun I, Rosenberg W, Kovacs AAZ, Tien PC. Longitudinal Assessment of the Enhanced Liver Fibrosis Score in the Era of Contemporary HIV and Hepatitis C Virus Treatment. J Infect Dis 2023; 227:1274-1281. [PMID: 35951669 PMCID: PMC10226657 DOI: 10.1093/infdis/jiac315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The trajectory of liver fibrosis is not well understood in the contemporary era of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) therapy. METHODS We assessed the Enhanced Liver Fibrosis (ELF) score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) in 116 women with HIV/HCV coinfection over a 4-year period. Random-effects linear regression models examined the rate of fibrosis change 1-2 years before starting HCV treatment, within 1 year before starting (peri-HCV treatment), within 1 year after and 1-2 years post-HCV treatment in unadjusted and adjusted models including age, race, and changes from pretreatment of factors that might affect fibrosis (eg, alcohol, integrase strand inhibitor [INSTI] use, waist circumference, CD4 count). RESULTS INSTI use nearly doubled from pre- to peri-HCV treatment. In unadjusted analysis, there was a 3.3% rate of rise in ELF pre-HCV treatment, 2.2% and 3.6% rate of decline during the peri- and 1-year post-HCV treatment period, respectively, followed by a 0.3% rise. Similar findings were observed for APRI and FIB-4. There was little effect on the estimated fibrosis trajectories after adjustment. CONCLUSIONS The apparent lack of decline in biomarkers of liver fibrosis beyond 1 year after HCV cure suggests that continued monitoring of liver fibrosis and interventions to mitigate progression in people with HIV after HCV cure remains essential.
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Affiliation(s)
| | - Yifei Ma
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jennifer C Price
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Audrey L French
- Department of Medicine, Stroger Hospital, Cook County Health, Chicago, Illinois, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Igho Ofotokun
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, United Kingdom
| | - Andrea A Z Kovacs
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Infectious Disease Section, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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22
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Zhou S, Qi K, Nugent BM, Bersoff-Matcha SJ, Struble K. Participation of HIV-1 infected treatment-naive females in clinical trials and sex differences in efficacy and safety outcomes. AIDS 2023; 37:895-903. [PMID: 36728423 DOI: 10.1097/qad.0000000000003478] [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: 02/03/2023]
Abstract
OBJECTIVES To examine female participation and the observed efficacy and safety by sex from phase 3 HIV-1 trials submitted to the United States Food and Drug Administration (FDA) to support approval or a major labeling change. DESIGN Our analyses were based on phase 3 trials in HIV-1 infected treatment-naive adults submitted to FDA since 2010. METHODS We evaluated enrollment of treatment-naive females in 18 clinical trials for HIV-1. Participation to prevalence ratio (PPR) was calculated as the percentage of females among trial participants divided by the percentage of females in the disease population. PPR between 0.8 and 1.2 reflects similar representation of females in the trial and the disease population. Sex differences in efficacy (virologic response rates) and selected safety events were evaluated. RESULTS United States (US) females, particularly US Black females were not adequately represented in clinical trials. The PPR for US females overall was 0.59 and for US Black females was 0.63. Statistically significant sex differences favoring males were observed for efficacy outcomes in both the global population and US participants. Statistically significant sex differences were observed for some safety outcomes. CONCLUSIONS US females are underrepresented in phase 3 HIV-1 clinical trials. Underrepresentation was not likely due to enrollment criteria. Statistically significant sex differences were noted for efficacy and selected safety outcomes; however, some differences were not clinically relevant. The ability to detect sex differences was hindered by low numbers of female participants overall and within subgroups. Additional research into innovative approaches to recruit and retain females in clinical trials should continue.
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Affiliation(s)
- Shuang Zhou
- Food and Drug Administration Office of Women's Health Center for Drug Evaluation and Research, Division of Antivirals
| | - Karen Qi
- Center for Drug Evaluation and Research, Office of Biostatistics
| | - Bridget M Nugent
- Center for Drug Evaluation and Research, Division of Rare Disease and Medical Genetics
| | | | - Kimberly Struble
- Center for Drug Evaluation and Research, Division of Antivirals, Food and Drug Administration, Silver Spring, Maryland, USA
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23
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Jao J, Kacanek D, Broadwell C, Jacobson DL, Chadwick EG, Williams PL, Powis KM, Haddad LB, Yee L. Gestational weight gain in persons with HIV in the United States. AIDS 2023; 37:883-893. [PMID: 36729961 PMCID: PMC10079618 DOI: 10.1097/qad.0000000000003454] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated gestational weight gain (GWG) in pregnant persons with HIV (PWH) enrolled in the Surveillance Monitoring for ART Toxicities study. DESIGN This was a cohort study. METHODS GWG was classified as excessive, adequate, or inadequate; weekly GWG in second and third trimesters was calculated using National Academy of Medicine standards. Adjusted modified Poisson and linear regression models were fit with generalized estimating equations to assess the association of antiretroviral treatment (ART) with GWG outcomes stratified by timing of ART initiation [at conception (ART-C) and initiating during pregnancy (ART-I)]. RESULTS We included 1477 pregnancies (847 ART-C, 630 ART-I) from 1282 PWH. The proportion of excessive, adequate, and inadequate GWG was 44, 24, and 32%, respectively. No associations of ART class with excessive GWG were observed overall. However, among ART-I pregnancies with overweight prepregnancy BMI-based, protease inhibitor-based, nonnucleoside reverse transcriptase inhibitor-based, and nucleoside reverse transcriptase inhibitor-based ART were associated with significantly lower GWG per week than integrase inhibitor (INSTI)-based ART [mean differences: -0.14, -0.27, and -0.29 kg/week, respectively]. Among ART-I pregnancies with obese prepregnancy BMI, lower weekly GWG was also observed for protease inhibitor-based vs. INSTI-based ART (mean difference: -0.14 kg/week). CONCLUSION ART class type was not associated with excessive GWG. However, PWH entering pregnancy already overweight/obese and initiating INSTI-based ART had higher weekly GWG in second and third trimesters vs. other ART classes. Further studies to understand how increases in weekly GWG for overweight/obese PWH impinges on long-term maternal/child health are warranted.
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Affiliation(s)
- Jennifer Jao
- Departments of Pediatrics and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carly Broadwell
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paige L Williams
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen M Powis
- Departments of Medicine and Pediatrics, Massachusetts General Hospital
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, New York
| | - Lynn Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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24
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Tieosapjaroen W, Chow EPF, Fairley CK, Hoy J, Aguirre I, Ong JJ. Weight Change When Initiating, Switching to, and Discontinuing Integrase Strand Transfer Inhibitors in People Living with HIV. AIDS Patient Care STDS 2023; 37:131-137. [PMID: 36809049 DOI: 10.1089/apc.2022.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Further investigations into the relationship between integrase strand transfer inhibitors (INSTIs) and weight gain are required, especially whether ceasing INSTI results in weight loss. We evaluated weight changes associated with different antiretroviral (ARV) regimens. A retrospective longitudinal cohort study was conducted using data extracted from the electronic clinical database at the Melbourne Sexual Health Centre, Australia, from 2011 to 2021. The association between weight change per time unit and ARV use in people living with HIV (PLWH) and the factors associated with weight changes when using INSTIs were estimated using a generalized estimated equation model. We included 1540 PLWH contributing 7476 consultations and 4548 person-years of data. ARV-naive PLWH initiating INSTIs gained an average of 2.55 kg/year (95% confidence interval 0.56 to 4.54; p = 0.012), while those using protease inhibitors and non-nucleoside reverse transcriptase inhibitors had no significant weight change. When switching off INSTIs, there was no significant weight change (p = 0.055). These weight changes were adjusted for age, gender, time on ARVs, and/or use of tenofovir alafenamide (TAF). Weight gain was the main reason PLWH ceased INSTIs. In addition, risk factors for weight gain in INSTI users were age younger than 60 years, male gender, and concomitant use of TAF. Weight gain was found among PLWH using INSTIs. After INSTI discontinuation, PLWH's weight stopped rising, but no weight loss was observed. Careful weight measurement after initiating INSTIs and early initiation of strategies to avoid weight gain will be important to prevent permanent weight gain and the associated morbidity.
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Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jennifer Hoy
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Ivette Aguirre
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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25
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Bailin SS, Koethe JR. Diabetes in HIV: the Link to Weight Gain. Curr HIV/AIDS Rep 2023; 20:9-18. [PMID: 36418528 PMCID: PMC10184162 DOI: 10.1007/s11904-022-00642-w] [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] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The burden of metabolic diseases, including type 2 diabetes mellitus (T2DM), is rising among persons with HIV (PWH) on antiretroviral therapy (ART). This increase coincides with an aging population and a greater proportion who are overweight/obese. This review summarizes the changing epidemic of T2DM on contemporary ART, the role of weight gain, and therapeutic options. RECENT FINDINGS Recent studies confirm that PWH face an epidemic of obesity and T2DM, similar to the general population. Contemporary ART is associated with greater weight gain and may contribute to the risk of T2DM. Recent advances in medical weight loss therapy offer a way forward in the prevention and treatment of weight-associated T2DM. Weight gain is one of the biggest contributors to T2DM in PWH. Future studies on the role of adipose tissue distribution, adipose tissue function and clinical use of effective weight loss medications may change the paradigm of care for PWH.
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Affiliation(s)
- Samuel S Bailin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Veterans Affairs, Tennessee Valley Health System, Nashville, TN, 37212, USA
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26
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Weight Gain and Metabolic Effects in Persons With HIV Who Switch to ART Regimens Containing Integrase Inhibitors or Tenofovir Alafenamide. J Acquir Immune Defic Syndr 2023; 92:67-75. [PMID: 36150045 DOI: 10.1097/qai.0000000000003101] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The timing and magnitude of antiretroviral therapy-associated weight change attributions are unclear. SETTING HIV Outpatient Study participants. METHODS We analyzed 2007-2018 records of virally suppressed (VS) persons without integrase inhibitor (INSTI) experience who switched to either INSTI-based or another non-INSTI-based ART, and remained VS. We analyzed BMI changes using linear mixed models, INSTI- and tenofovir alafenamide (TAF) contributions to BMI change by linear mixed models-estimated slopes, and BMI inflection points. RESULTS Among 736 participants (5316 person-years), 441 (60%) switched to INSTI-based ART; the remainder to non-INSTI-based ART. The mean follow-up was 7.15 years for INSTI recipients and 7.35 years for non-INSTI. Preswitch, INSTI and non-INSTI groups had similar median BMI (26.3 versus 25.9 kg/m 2 , P = 0.41). INSTI regimens included raltegravir (178), elvitegravir (112), and dolutegravir (143). Monthly BMI increases postswitch were greater with INSTI than non-INSTI (0.0525 versus 0.006, P < 0.001). A BMI inflection point occurred 8 months after switch among INSTI users; slopes were similar regardless of TAF use immediately postswitch. Among INSTI + TAF users, during 8 months postswitch, 87% of BMI slope change was associated with INSTI use, 13% with TAF use; after 8 months, estimated contributions were 27% and 73%, respectively. For non-INSTI+TAF, 84% of BMI gain was TAF-associated consistently postswitch. Persons switching from TDF to TAF had greater BMI increases than others ( P < 0.001). CONCLUSION Among VS persons who switched ART, INSTI and TAF use were independently associated with BMI increases. During 8 months postswitch, BMI changes were greatest and most associated with INSTI use; afterward, gradual BMI gain was largely TAF-associated.
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27
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Hirigo AT, Yilma D, Astatkie A, Debebe Z. Effect of dolutegravir-based first-line antiretroviral therapy on weight and body mass index among adult people living with HIV on follow up at health facilities in Hawassa city administration, Southern Ethiopia: a retrospective cohort study. Ann Med 2023; 55:2242250. [PMID: 37531412 PMCID: PMC10399476 DOI: 10.1080/07853890.2023.2242250] [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: 03/30/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The nature and burden of weight gain associated with antiretroviral treatment (ART) using a combination of Tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) among people living with HIV (PLWH) has not been thoroughly investigated in Ethiopia. Therefore, this study aimed to evaluate changes in body weight and body mass index (BMI) in adults who initiated TLD or switched to TLD compared to those who received a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapies. METHODS A retrospective cohort study was conducted among adult PLWH who had been receiving ART between February 2017 and October 2022 in Hawassa city administration, Sidama region. Linear mixed-effects model was used to examine BMI and body weight trends over time, while a binary logistic regression was performed to identify factors associated with a ≥ 10% weight gain. RESULTS A total of 524 adult PLWH with a median age of 35 (interquartile range: 30-41) years were included. TLD-initiated arm experienced significantly greater mean weight (8.6 kg vs. 4.95 kg, p < 0.0001) and BMI (3.11 kg/m2 vs. 1.84 kg/m2, p < 0.0001) increase than the NNRTI-based arm at two years. However, the switched arm showed no significant difference in weight (5.6 kg) and BMI (2.13 kg/m2) compared to the NNRTI-based arm (p > 0.05). There was a significant interaction effect between ART regimens and time in predicting weight and BMI gain (p < 0.01). Initiating ART with TLD had higher odds of ≥10% body weight gain at two years (adjusted odds ratio [AOR]: 1.9; 95% CI: 1.19-3.04). Other baseline factors such as age ≥40 years (AOR: 2.02; 95% CI: 1.35-3.02), weight <50kg (AOR: 3.0; 95% CI: 1.86-4.84), advanced disease stages (AOR: 1.78; 95% CI: 1.1-2.86) and ambulatory-bedridden functional status (AOR: 2.0; 95% CI: 1.05-3.8) were also associated with ≥10% weight gain. CONCLUSION Initiating ART with TLD was significantly associated with greater weight and BMI gain than the NNRTI-based regimens. Therefore, the cardio-metabolic implications of weight gain after the TLD initiation in this population should be monitored and thoroughly investigated.
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Affiliation(s)
- Agete Tadewos Hirigo
- School of Medical Laboratory Science, College of Medicine Health Sciences, Hawassa University, Hawassa, Ethiopia
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
- Jimma University Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Debebe
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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28
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Castle AC, Hoeppner SS, Magodoro IM, Singh U, Moosa Y, Bassett IV, Wong EB, Siedner MJ. Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population. PLoS One 2023; 18:e0282371. [PMID: 36928895 PMCID: PMC10019670 DOI: 10.1371/journal.pone.0282371] [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: 09/21/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) may predispose individuals to the development of diabetes. Such a relationship could have an outsized impact in high-prevalence TB settings. However, few studies have explored this relationship in populations heavily burdened by diabetes and TB. METHODS We analyzed data from a community-based population cohort that enrolled adults in rural South Africa. Individuals were considered to have prior TB if they self-reported a history of TB treatment. We fitted sex-specific logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between dysglycemia (HBA1c ≥6.5%) and prior TB. Propensity score-matched cohorts accounted for the differential age distributions between comparator groups. We examined the interactions between sex, prior TB, and HIV status. RESULTS In the analytic cohort (n = 17,593), the prevalence of prior TB was 13.8% among men and 10.7% among women. Dysglycemia was found in 9.1% of the population, and HIV prevalence was 34.0%. We found no difference in dysglycemia prevalence by prior TB (men OR 0.96, 95% CI 0.60-1.56: women OR 1.05, 95% CI 0.79-1.39). However, there was a qualitative interaction by HIV serostatus, such that among men without HIV, those with a history of TB had a greater prevalence of dysglycemia than those without prior TB (10.1% vs. 4.6%, p = 0.0077). An inverse relationship was observed among men living with HIV (prior TB 3.3% vs. no TB 7.3%, p = 0.0073). CONCLUSIONS Treated TB disease was not associated with dysglycemia in an HIV-endemic, rural South African population. However, we found a significant interaction between prior TB and HIV status among men, suggesting distinct pathophysiological mechanisms between the two infections that may impact glucose metabolism. Longitudinal studies are needed to better establish a causal effect and underlying mechanisms related to resolved TB, HIV, and diabetes.
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Affiliation(s)
- Alison C. Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | | | - Itai M. Magodoro
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Yumna Moosa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Ingrid V. Bassett
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Emily B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, Alabama, United States of America
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Simsek A, Karabay O, Guclu E, Toptan H. Comparison of Metabolic Effects of Three Different Treatment Combinations with Retrospective Real-life Data in People Living with HIV. Curr HIV Res 2023; 21:314-322. [PMID: 37990894 DOI: 10.2174/011570162x266922231107094649] [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: 06/27/2023] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Comorbidities are increasing in people living with HIV (PLHIV), and different treatment options have advantages and disadvantages. It is important to compare information from real-life treated cases. The aim of this study was to retrospectively evaluate the data on efficacy and clinical and laboratory findings during different antiretroviral therapies. METHODS Retrospective file data of 47 PLHIV using Dolutegravir and Lamivudine (3TC/DTG), Tenofovir Alafenamide Emtricitabine and Elvitegravir Cobicistat (EVG/c/TAF/FTC) and Tenofovir Disoproxil Fumarate and Emtricitabine and Efavirenz (EFV/FTC/TDF) were analyzed. Data of the patients at baseline and 12 months after antiretroviral therapy (ART) were compared. RESULTS About 47 PLHIV were included in the study. Of the patients, 22 (46.8%) were in the 3TC/DTG group, 19 (40.4%) in the EVG/c/TAF/FTC, and 6 (12.8%) in the EFV/FTC/TDF group. After 12 months of treatment, BMI, HIV-RNA, CD4, WBC, hemoglobin, MCV, PDW, RDW, platelet count, creatinine, eGFR, HDL, AST, glucose values of the 3TC/DTG group were significantly different (p<0.05). After 12 months of treatment, BMI, HIV-RNA, CD4 count, MCV, creatinine, eGFR, HDL, LDL, TG, TC, AST, and HOMA-IR values of the EVG/c/TAF/FTC treatment group were significantly different (p<0.05). After 12 months of treatment, HIV RNA, total bilirubin, and LDL values in the EFV/FTC/TDF treatment group were statistically different (p<0.05). CONCLUSION All treatment groups showed a decrease in HIV-RNA and an increase in CD4 at the end of one year. While CD4 elevation is lower in EFV recipients than in integrase inhibitor (INSTI) recipients, weight gain is higher in INSTI recipients. While the lipid profile was more positively affected in the 3TC/DTG group, lipid profiles were more negatively affected in the EVG/c/TAF/FTC group, although liver and kidney functions were preserved.
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Affiliation(s)
- Adem Simsek
- Sakarya University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya
| | - Oguz Karabay
- Sakarya University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya
| | - Ertugrul Guclu
- Sakarya University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya
| | - Hande Toptan
- Sakarya Training and Research Hospital, Department of Microbiology, Sakarya
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30
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Foster EG, Gendelman HE, Bade AN. HIV-1 Integrase Strand Transfer Inhibitors and Neurodevelopment. Pharmaceuticals (Basel) 2022; 15:1533. [PMID: 36558984 PMCID: PMC9783753 DOI: 10.3390/ph15121533] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Children born to mothers, with or at risk, of human immunodeficiency virus type-1 (HIV-1) infection are on the rise due to affordable access of antiretroviral therapy (ART) to pregnant women or those of childbearing age. Each year, up to 1.3 million HIV-1-infected women on ART have given birth with recorded mother-to-child HIV-1 transmission rates of less than 1%. Despite this benefit, the outcomes of children exposed to antiretroviral drugs during pregnancy, especially pre- and post- natal neurodevelopment remain incompletely understood. This is due, in part, to the fact that pregnant women are underrepresented in clinical trials. This is underscored by any potential risks of neural tube defects (NTDs) linked, in measure, to periconceptional usage of dolutegravir (DTG). A potential association between DTG and NTDs was first described in Botswana in 2018. Incidence studies of neurodevelopmental outcomes associated with DTG, and other integrase strand transfer inhibitors (INSTIs) are limited as widespread use of INSTIs has begun only recently in pregnant women. Therefore, any associations between INSTI use during pregnancy, and neurodevelopmental abnormalities remain to be explored. Herein, United States Food and Drug Administration approved ARVs and their use during pregnancy are discussed. We provide updates on INSTI pharmacokinetics and adverse events during pregnancy together with underlying mechanisms which could affect fetal neurodevelopment. Overall, this review seeks to educate both clinical and basic scientists on potential consequences of INSTIs on fetal outcomes as a foundation for future scientific investigations.
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Affiliation(s)
- Emma G. Foster
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Howard E. Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Aditya N. Bade
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
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31
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Jung I, Tu-Sekine B, Jin S, Anokye-Danso F, Ahima RS, Brown TT, Kim SF. Dolutegravir Suppresses Thermogenesis via Disrupting Uncoupling Protein 1 Expression and Mitochondrial Function in Brown/Beige Adipocytes in Preclinical Models. J Infect Dis 2022; 226:1626-1636. [PMID: 35512127 DOI: 10.1093/infdis/jiac175] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) containing integrase strand transfer inhibitors (INSTIs) has been associated with weight gain in both ART initiation and switch studies, especially in women, but the underlying mechanisms are unclear. METHODS The effects of dolutegravir (DTG) on food intake, energy expenditure, oxygen consumption in female mice, and gene expression from adipose tissues were assessed. Human and murine preadipocytes were treated with DTG either during differentiation into mature brown/beige adipocytes or postdifferentiation. Lipid accumulation, lipolysis, β-adrenergic response, adipogenic markers, mitochondrial respiration, and insulin response were analyzed. RESULTS Two-week administration of DTG to female mice reduced energy expenditure, which was accompanied by decreased uncoupling protein 1 (UCP1) expression in brown/beige adipose tissues. In vitro studies showed that DTG significantly reduced brown adipogenic markers, especially UCP1 in brown and beige adipocytes, whereas drugs from other classes did not. Furthermore, a loss of UCP1 by DTG led to a decrease in mitochondrial complex IV component, followed by a reduction in mitochondrial respiratory capacity and reduced insulin-stimulated glucose uptake. CONCLUSIONS Our findings show that DTG targets UCP1 and mitochondrial functions in brown and beige adipocytes and disrupts thermogenic functions in preclinical models, providing the potential mechanisms by which DTG suppresses energy expenditure leading to weight gain.
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Affiliation(s)
- IkRak Jung
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Becky Tu-Sekine
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sunghee Jin
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Frederick Anokye-Danso
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rexford S Ahima
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sangwon F Kim
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
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Byonanebye DM, Polizzotto MN, Neesgaard B, Sarcletti M, Matulionyte R, Braun DL, Castagna A, de Wit S, Wit F, Fontas E, Vehreschild J, Vesterbacka J, Greenberg L, Hatleberg C, Garges H, Gallant J, Volny Anne A, Öllinger A, Mozer‐Lisewska I, Surial B, Spagnuolo V, Necsoi C, van der Valk M, Mocroft A, Law M, Ryom L, Petoumenos K. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Med 2022; 23:895-910. [PMID: 35233903 PMCID: PMC9545382 DOI: 10.1111/hiv.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND.
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Affiliation(s)
- Dathan M. Byonanebye
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia,School of Public HealthMakerere UniversityKampalaUganda
| | - Mark N. Polizzotto
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bastian Neesgaard
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mario Sarcletti
- Department of Dermatology, Venerology and AllergologyMedical University InnsbruckInnsbruckAustria
| | - Raimonda Matulionyte
- Department of Infectious Diseases and DermatovenerologyFaculty of MedicineVilnius University Hospital Santaros KlinikosVilnius UniversityVilniusLithuania
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital EpidemiologySwitzerland Swiss HIV Cohort Study (SHCS)Institute of Medical VirologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Antonella Castagna
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Stéphane de Wit
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands
| | - Eric Fontas
- Nice HIV CohortUniversité Côte d’Azur et Centre Hospitalier UniversitaireNiceFrance
| | - Jörg Janne Vehreschild
- Medical Department 2Hematology/OncologyUniversity Hospital of FrankfurtFrankfurtGermany,Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Jan Vesterbacka
- Swedish InfCare HIV CohortKarolinska University HospitalHuddingeSweden
| | - Lauren Greenberg
- Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Camilla Hatleberg
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | | | | | - Angela Öllinger
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | - Bernard Surial
- Department of Infectious Diseases, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Vincenzo Spagnuolo
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Coca Necsoi
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands,Division of Infectious DiseasesDepartment of Internal MedicineAmsterdam Institute for Infection and ImmunityAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Amanda Mocroft
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark,Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Matthew Law
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lene Ryom
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kathy Petoumenos
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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Pantazis N, Papastamopoulos V, Antoniadou A, Adamis G, Paparizos V, Metallidis S, Sambatakou H, Psichogiou M, Chini M, Chrysos G, Panagopoulos P, Sipsas NV, Barbunakis E, Gogos C, Touloumi G. Changes in Body Mass Index after Initiation of Antiretroviral Treatment: Differences by Class of Core Drug. Viruses 2022; 14:v14081677. [PMID: 36016299 PMCID: PMC9415309 DOI: 10.3390/v14081677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Recent research on antiretroviral treatment (ART) for HIV suggests that integrase strand transfer inhibitors (INSTIs) cause faster weight gain compared to other drug classes. Here, we investigated changes in body mass index (BMI) and obesity prevalence after treatment initiation and corresponding differences between drug classes. Data were derived from a large collaborative cohort in Greece. Included individuals were adults who started ART, in or after 2010, while previously ART naïve and achieved virologic response within the first year of ART. Data were analysed using mixed fractional polynomial models. INSTI regimens led to the more pronounced BMI increases, followed by boosted PI and NNRTI based regimens. Individuals with normal initial BMI are expected to gain 6 kg with an INSTI regimen compared to 4 kg with a boosted PI and less than 3 kg with a NNRTI regimen after four years of treatment. Prevalence of obesity was 5.7% at ART initiation and 12.2%, 14.2% and 18.1% after four years of treatment with NNRTIs, PIs, and INSTIs, respectively. Dolutegravir or Raltegravir were associated with marginally faster BMI increase compared to Elvitegravir. INSTIs are associated with faster weight gain. INSTIs' increased risk of treatment emergent obesity and, possibly, weight-related co-morbidities should be judged against their improved efficacy and tolerability but increased clinical attention is required.
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Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
- Correspondence:
| | - Vasilios Papastamopoulos
- 5th Department of Internal Medicine—Division of Infectious Diseases, Evangelismos General Hospital of Athens, 10676 Athens, Greece;
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Georgios Adamis
- 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas, 11527 Athens, Greece;
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece;
| | - Simeon Metallidis
- 1st Internal Medicine Department, Medical School, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Medical School, Hippokration University General Hospital, 11527 Athens, Greece;
| | - Mina Psichogiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Chini
- 3rd Department of Internal Medicine—Infectious Diseases Unit, Red Cross General Hospital, 11526 Athens, Greece;
| | - Georgios Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, 18536 Athens, Greece;
| | - Periklis Panagopoulos
- Department of Internal Medicine, University Hospital of Alexandroupoli, 68100 Alexandroupolis, Greece;
| | - Nikolaos V. Sipsas
- Infectious Diseases Unit, Department of Pathophysiology, Medical School, Laikon Athens General Hospital and National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Emmanouil Barbunakis
- Department of Internal Medicine, University Hospital of Heraklion, 71500 Heraklion, Crete, Greece;
| | - Charalambos Gogos
- Department of Internal Medicine & Infectious Diseases, Patras University General Hospital, 26504 Patras, Greece;
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Alhassan Y, Twimukye A, Malaba T, Myer L, Waitt C, Lamorde M, Colbers A, Reynolds H, Khoo S, Taegtmeyer M. "It's only fatness, it doesn't kill": a qualitative study on perceptions of weight gain from use of dolutegravir-based regimens in women living with HIV in Uganda. BMC Womens Health 2022; 22:246. [PMID: 35729541 PMCID: PMC9210809 DOI: 10.1186/s12905-022-01814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dolutegravir (DTG)-based regimens have been recommended by the WHO as the preferred first-line and second-line HIV treatment in all populations. Evidence suggests an association with weight gain, particularly among black women. Our study investigated perceptions of weight gain from DTG-based regimen use on body image and adherence of antiretroviral therapy in women living with HIV (WLHIV) in Uganda. Methods Between April and June 2021, we conducted semi-structured interviews involving 25 WLHIV (adolescents, women of reproductive potential and post-menopausal women) and 19 healthcare professionals (clinicians, nurses, ART managers and counsellors) purposively selected from HIV clinics in Kampala. The interviews explored perceptions of body weight and image; experiences and management of weight related side effects associated with DTG; and knowledge and communication of DTG-related risks. Data was analysed thematically in NVivo 12 software. Results Our findings indicate WLHIV in Uganda commonly disliked thin body size and aspired to gain moderate to high level body weight to improve their body image, social standing and hide their sero-positive status. Both WLHIV and healthcare professionals widely associated weight gain with DTG use, although it was rarely perceived as an adverse event and was unlikely to be reported or to alter medication adherence. Clinical management and pharmacovigilance of DTG-related weight gain were hampered by the limited knowledge of WLHIV of the health risks of being over-weight and obesity; lack of diagnostic equipment and resources; and limited clinical guidance for managing weight gain and associated cardiovascular and metabolic comorbidities. Conclusions The study highlights the significance of large body-size in promoting psychosocial wellbeing in WLHIV in Uganda. Although weight gain is recognized as a side effect of DTG, it may be welcomed by some WLHIV. Healthcare professionals should actively talk about and monitor for weight gain and occurrence of associated comorbidities to facilitate timely interventions. Improved supply of diagnostic equipment and support with sufficient guidance for managing weight gain for healthcare professionals in Uganda are recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01814-x.
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Affiliation(s)
- Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Thokozile Malaba
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Angela Colbers
- Radboud University Nijmegen Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Helen Reynolds
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
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Esber AL, Chang D, Iroezindu M, Bahemana E, Kibuuka H, Owuoth J, Singoei V, Maswai J, Dear NF, Crowell TA, Polyak CS, Ake JA. Weight gain during the dolutegravir transition in the African Cohort Study. J Int AIDS Soc 2022; 25:e25899. [PMID: 35419973 PMCID: PMC9008168 DOI: 10.1002/jia2.25899] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/15/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Dolutegravir (DTG) has become a preferred component of first‐line antiretroviral therapy (ART) in many settings but may be associated with excess weight gain. We evaluated changes in weight and body mass index (BMI) after switch to single‐tablet tenofovir/lamivudine/dolutegravir (TLD) by people living with HIV (PLWH) in four African countries. Methods The African Cohort Study (AFRICOS) prospectively follows adults with and without HIV in Kenya, Uganda, Tanzania and Nigeria. Demographics, ART regimen, weight, BMI and waist‐to‐hip ratio were collected every 6 months. Multivariable Cox proportional hazards modelling was used to estimate hazard ratios and 95% confidence intervals (CIs) for factors associated with developing a BMI ≥25 kg/m2. Linear mixed effects models with random effects were used to examine the average change in BMI, weight and waist‐to‐hip ratio. Results From 23 January 2013 to 1 December 2020, 2950 PLWH were enrolled in AFRICOS and 1474 transitioned to TLD. In adjusted models, PLWH on TLD had 1.77 times the hazard of developing a high BMI (95% CI: 1.22–2.55) compared to PLWH on non‐TLD ART. Examining change in weight among all PLWH on ART, participants on TLD gained an average of 0.68 kg (95% CI: 0.32–1.04) more than PLWH on other regimens after adjusting for duration on ART, sex, age, study site and CD4 nadir. Among participants who switched to TLD, the average change in weight prior to TLD switch was 0.35 kg/year (95% CI: 0.25–0.46) and average change in weight was 1.46 kg/year (95% CI: 1.18–1.75) in the year following transition to TLD after adjustment for confounders. Conclusions Elevated BMI and weight gain among PLWH on TLD are concerning safety signals. Implications for the development of metabolic comorbidities should be monitored, particularly if annual weight gain persists during continued follow‐up after transitioning to TLD.
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Affiliation(s)
- Allahna L Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,HJF Medical Research International, Mbeya, Tanzania
| | - Hannah Kibuuka
- Makerere University-Walter Reed Project, Kampala, Uganda
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Valentine Singoei
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Jonah Maswai
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kericho, Kenya
| | - Nicole F Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Diggins CE, Russo SC, Lo J. Metabolic Consequences of Antiretroviral Therapy. Curr HIV/AIDS Rep 2022; 19:141-153. [PMID: 35299263 DOI: 10.1007/s11904-022-00600-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review reports on published studies describing metabolic changes associated with antiretroviral therapy (ART) to treat HIV disease including a historical perspective of earlier ART agents, but with the main focus on newer ART agents currently in use. RECENT FINDINGS Studies from different countries around the world have shown that integrase inhibitor (INSTI)-based regimens as well as tenofovir alafenamide (TAF) are associated with weight gain, with women and people of black race at especially high risk. Some studies preliminarily suggest worsened metabolic outcomes associated with this weight gain including adverse effects on glucose homeostasis. Antiretroviral therapy can affect weight, adipose tissue, glucose, and lipids. As obesity is prevalent and increasing among people with HIV, awareness of risk factors for weight gain, including the ART medications associated with greater weight gain, are needed in order to inform prevention efforts. Further research is needed to better understand the long-term health consequences of INSTI- and TAF-associated weight increases.
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Affiliation(s)
- Caroline E Diggins
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, LON-207, 55 Fruit Street, Boston, MA, 02114, USA
| | - Samuel C Russo
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, LON-207, 55 Fruit Street, Boston, MA, 02114, USA
| | - Janet Lo
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, LON-207, 55 Fruit Street, Boston, MA, 02114, USA.
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Asundi A, Olson A, Jiang W, Varshney SP, White LF, Sagar M, Lin NH. Integrase Inhibitor Use Associated with Weight Gain in Women and Incident Diabetes Mellitus. AIDS Res Hum Retroviruses 2022; 38:208-215. [PMID: 34877881 PMCID: PMC8968841 DOI: 10.1089/aid.2021.0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Excessive weight gain associated with integrase strand transfer inhibitor (InSTI) antiretrovirals is an emerging issue; however, the metabolic consequences of this effect have not been established. Our objective was to evaluate for InSTI-emergent weight gain and potential associated type 2 diabetes mellitus (T2DM) among a diverse HIV patient cohort. For this retrospective cohort study, we obtained clinical warehouse data for HIV+ patients between fiscal years 2007-17. We compared patients initiated on an InSTI with those started on an alternate regimen. Our primary outcome was percentage weight change from baseline to 24 months postinitiation using the linear mixed-effects model fit by restricted maximum likelihood. Our secondary outcome was incident T2DM as defined by a new prescription for antihyperglycemic medication within 18 months after antiretroviral therapy (ART) start. Diabetes-free survival was estimated using the Kaplan-Meier method, log-rank test, and Cox proportional-hazards model. The cohort included 1,235 individuals initiating ART, 136 (11.0%) with an InSTI. InSTI use in women was significantly associated with greater weight gain compared with non-InSTIs (11.0%, 95% confidence interval, CI: 5.22 to 16.8, p < .01), after adjusting for potential confounding variables. In a univariate analysis, InSTI use was associated with more incident T2DM diagnoses compared with non-InSTI regimens (unadjusted hazard ratio = 3.27, p = .01), although incident T2DM was not associated with weight gain. InSTIs were significantly associated with weight gain among females. We also observed an increased risk of incident diabetes mellitus among both sexes, however, unrelated to weight changes. Further prospective studies will be necessary to confirm this finding and investigate its mechanism.
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Affiliation(s)
- Archana Asundi
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Alex Olson
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Wenqing Jiang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Swati P. Varshney
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Manish Sagar
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Nina H. Lin
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
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38
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Moran CA, Collins LF, Beydoun N, Mehta PK, Fatade Y, Isiadinso I, Lewis TT, Weber B, Goldstein J, Ofotokun I, Quyyumi A, Choi MY, Titanji K, Lahiri CD. Cardiovascular Implications of Immune Disorders in Women. Circ Res 2022; 130:593-610. [PMID: 35175848 PMCID: PMC8869407 DOI: 10.1161/circresaha.121.319877] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immune responses differ between men and women, with women at higher risk of developing chronic autoimmune diseases and having more robust immune responses to many viruses, including HIV and hepatitis C virus. Although immune dysregulation plays a prominent role in chronic systemic inflammation, a key driver in the development of atherosclerotic cardiovascular disease (ASCVD), standard ASCVD risk prediction scores underestimate risk in populations with immune disorders, particularly women. This review focuses on the ASCVD implications of immune dysregulation due to disorders with varying global prevalence by sex: autoimmune disorders (female predominant), HIV (male-female equivalent), and hepatitis C virus (male predominant). Factors contributing to ASCVD in women with immune disorders, including traditional risk factors, dysregulated innate and adaptive immunity, sex hormones, and treatment modalities, are discussed. Finally, the need to develop new ASCVD risk stratification tools that incorporate variables specific to populations with chronic immune disorders, particularly in women, is emphasized.
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Affiliation(s)
- Caitlin A. Moran
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Lauren F. Collins
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Nour Beydoun
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Puja K. Mehta
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Yetunde Fatade
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Ijeoma Isiadinso
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Tené T Lewis
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA
| | - Brittany Weber
- Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jill Goldstein
- Massachusetts General Hospital, Department of Psychiatry, and Harvard Medical School, Departments of Psychiatry and Medicine, Boston, MA, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Arshed Quyyumi
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - May Y. Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Kehmia Titanji
- Emory University, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA, USA
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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Hester EK, Greenlee S, Durham SH. Weight Changes With Integrase Strand Transfer Inhibitor Therapy in the Management of HIV Infection: A Systematic Review. Ann Pharmacother 2022; 56:10600280211073321. [PMID: 35130714 DOI: 10.1177/10600280211073321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe weight changes with integrase strand transfer inhibitor (INSTI) therapy. DATA SOURCES A literature search was performed (through December 15, 2021) using the PubMed and CINAHL databases using the search terms: "integrase inhibitors," "integrase strand transfer inhibitors," and "weight." STUDY SELECTION AND DATA EXTRACTION Studies were included that provided relevant information on weight or body mass index (BMI) changes on INSTI therapy. Controlled or observational studies comparing different INSTI therapies or compared INSTI therapy to another class of antiretroviral therapy were included. DATA SYNTHESIS Forty-three articles met criteria for inclusion, and data are presented. Although some trials have observed similar weight gains between INSTI, protease inhibitor, and non-nucleoside inhibitor therapies, the increase appears to be greater with INSTI therapy, particularly during initiation of therapy. Risk factors for weight gain with INSTI therapy include female gender, lower CD4 count, and combined use of tenofovir alafenamide. Within the INSTI class, dolutegravir and bictegravir appear to have the greatest propensity for weight gain. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE INSTI-based therapies are the preferred initial management of HIV infection. Discerning the factors contributing to weight changes on INSTI therapy and risks of associated health-related outcomes is important to both the management of weight gain and HIV medical management. CONCLUSIONS Within the INSTI class, dolutegravir and bictegravir may be associated with the greatest risk for weight gain particularly when combined with tenofovir alafenamide. Further research is needed to determine mechanisms for observed weight changes and any contributions to clinically significant metabolic and cardiovascular adverse outcomes associated with INSTI therapy.
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Affiliation(s)
- E Kelly Hester
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Sage Greenlee
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Spencer H Durham
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
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40
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Chen YW, Anderson D, Pericone CD, Donga P. Real-World Assessment of Weight Change in African American Females and Hispanics with HIV-1 After Initiating Integrase Strand-Transfer Inhibitors or Protease Inhibitors. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:1-10. [PMID: 35083364 PMCID: PMC8723886 DOI: 10.36469/001c.30184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Background: Studies have shown an increase in weight among people living with HIV (PLWH) who initiated integrase strand transfer inhibitors (INSTI). However, weight gain with INSTI-based regimens vs other regimens in females or racial/ethnic minorities is poorly understood. Objective: This study assessed differences in weight gain among treatment-naïve, female, African Americans and Hispanics after initiating INSTI-based vs protease inhibitor (PI)-based regimens. Methods: This retrospective, observational cohort study included data from the Optum® deidentified Electronic Health Record Database. Female African Americans or Hispanics initiating INSTI- or PI-based regimens between January 1, 2015, and December 31, 2018 (first prescription was index date), with ≥12-month baseline and follow-up periods, ≥1 weight measure during each period, and no prior antiretroviral (ARV) use were included. Inverse probability of treatment weighting was used to reduce selection bias and improve cohort comparability. Multivariable models were used to compare absolute weight/body mass index (BMI) changes and proportion of patients with weight/BMI increases from pre- to post-index (last measure between the 4th and 12th months post-index). Results: Weighted cohorts included 3407 African American females (INSTI, 1704; PI, 1703) and 3711 Hispanics (INSTI, 1865; PI, 1846) PLWH. Mean time to follow-up weight measure was ~9.5 months. Among female African Americans, INSTI initiators had a 1.5 kg greater mean weight gain (2.1 kg vs 0.6 kg; P = 0.033), and a higher proportion with ≥5% weight gain (32% vs 29%; odds ratio [OR]=1.2; 95% CI [1.0-1.4]) than PI initiators. Among Hispanics, INSTI and PI initiators had similar mean increases in weight (2.1 and 1.8 kg, respectively), but INSTI initiators had a higher proportion with ≥5% weight gain (31% vs 27%; OR=1.2; 95% CI [1.1-1.4]). Female African American INSTI initiators were more likely to shift from normal or overweight to a worse BMI classification. Hispanic INSTI initiators were less likely to shift from normal BMI to overweight but more likely to shift from normal or overweight to obese. Conclusion: In a real-world setting, INSTI-based regimens were associated with greater weight gain for treatment-naïve female African Americans, compared with PI-based regimens. Differences between regimens were less consistent for Hispanics. These results may inform ARV choice for PLWH who are at risk for ARV-related weight gain.
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Affiliation(s)
- Yen-Wen Chen
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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41
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Chang HH. Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients. Infect Chemother 2022; 54:220-235. [PMID: 35706080 PMCID: PMC9259920 DOI: 10.3947/ic.2022.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
While human immunodeficiency virus (HIV)-associated wasting has declined with significant advances in antiretroviral therapy (ART), weight gain and metabolic syndrome (MetS) are now becoming a problem for people living with HIV (PLWH) worldwide. The development of a new and more effective ART regimen has increased viral suppression and improved immunologic function recovery, leading to the extension of the lifespan of PLWH. It has recently been reported as one of the significant factors associated with weight gain, obesity, and long-term metabolic consequences in PLWH. This article reviewed the epidemiology of overweight and MetS among PLWH and the known risk factors for weight gain and its major comorbidities, such as dyslipidemia, diabetes mellitus, cardiovascular diseases, neurocognitive disorders, and liver diseases, in PLWH. In addition, reports on the pharmacological and surgical management of overweight and obesity in PLWH has been briefly summarized.
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Affiliation(s)
- Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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42
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Pond RA, Collins LF, Lahiri CD. Sex Differences in Non-AIDS Comorbidities Among People With Human Immunodeficiency Virus. Open Forum Infect Dis 2021; 8:ofab558. [PMID: 34888399 PMCID: PMC8651163 DOI: 10.1093/ofid/ofab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
Women are grossly underrepresented in human immunodeficiency virus (HIV) clinical and translational research. This is concerning given that people with HIV (PWH) are living longer, and thus accumulating aging-related non-AIDS comorbidities (NACMs); emerging evidence suggests that women are at higher risk of NACM development and progression compared with men. It is widely recognized that women vs men have greater immune activation in response to many viruses, including HIV-1; this likely influences sex-differential NACM development related to differences in HIV-associated chronic inflammation. Furthermore, many sociobehavioral factors that contribute to aging-related NACMs are known to differ by sex. The objectives of this review were to (1) synthesize sex-stratified data on 4 NACMs among PWH: bone disease, cardiovascular disease, metabolic dysfunction, and neurocognitive impairment; (2) evaluate the characteristics of key studies assessing sex differences in NACMs; and (3) introduce potential biological and psychosocial mechanisms contributing to emerging trends in sex-differential NACM risk and outcomes among PWH.
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Affiliation(s)
- Renee A Pond
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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43
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Kileel EM, Lo J, Malvestutto C, Fitch KV, Zanni MV, Fichtenbaum CJ, Overton ET, Okeke NL, Kumar P, Joao E, Aberg JA, Martinez E, Currier JS, Douglas PS, Ribaudo HJ, Grinspoon SK. Assessment of Obesity and Cardiometabolic Status by Integrase Inhibitor Use in REPRIEVE: A Propensity-Weighted Analysis of a Multinational Primary Cardiovascular Prevention Cohort of People With Human Immunodeficiency Virus. Open Forum Infect Dis 2021; 8:ofab537. [PMID: 34888395 PMCID: PMC8651160 DOI: 10.1093/ofid/ofab537] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emerging data demonstrate that the use of integrase inhibitor (INSTI)-based antiretroviral treatment (ART) is associated with increased weight, but the cardiometabolic health consequences of increased weight remains poorly understood. METHODS This analysis examined INSTI use (>6 months) at entry among REPRIEVE participants enrolled in High Income and Latin America/Caribbean Global Burden of Disease regions. Primary analyses used linear and logistic regression; secondary analyses used quantile regression to examine differences across the full data distribution. Characteristics of those with and without INSTI use were balanced using inverse probability of treatment weighting. RESULTS Among 4500 REPRIEVE participants, 1848 were on an INSTI-based regimen at entry for an average of 2.1 ± 1.8 years. Integrase inhibitor use (vs no INSTI use) was associated with higher odds of obesity (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.4-1.9) and higher mean body mass index ([BMI] +1.5kg/m2; 95% CI, 1.0-1.9) and waist circumference (+3.6cm; 95% CI, 2.6-4.6). Differences in weight related to INSTI use were greater in the upper tails of the distribution (+3.1kg/m2 [95% CI, 1.9-4.4] at the 90th centile vs +0.7kg/m2 [95% CI, 0.2-1.2] at the 50th centile) and among women and nonwhite participants, with sex and race having an additive effect on BMI. Conversely, INSTI use was not associated with differences in glucose, low-density lipoprotein cholesterol, or higher odds of metabolic syndrome or hypertension. CONCLUSIONS Differences in weight and waist circumference associated with INSTI use are (1) not uniform across people with human immunodeficiency virus, (2) greatest among women and nonwhites, and (3) concentrated at the upper tails of weight distribution. These data identify at-risk subgroups for whom long-term cardiovascular disease outcomes should be carefully assessed.
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Affiliation(s)
- Emma M Kileel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Janet Lo
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | - Princy Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Esau Joao
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Judith A Aberg
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Judith S Currier
- University of California at Los Angeles, Los Angeles, California, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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44
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Leonard MA, Cindi Z, Bradford Y, Bourgi K, Koethe J, Turner M, Norwood J, Woodward B, Erdem H, Basham R, Baker P, Rebeiro PF, Sterling TR, Hulgan T, Daar ES, Gulick R, Riddler SA, Sinxadi P, Ritchie MD, Haas DW. Efavirenz Pharmacogenetics and Weight Gain Following Switch to Integrase Inhibitor-Containing Regimens. Clin Infect Dis 2021; 73:e2153-e2163. [PMID: 32829410 PMCID: PMC8492125 DOI: 10.1093/cid/ciaa1219] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/14/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Unwanted weight gain affects some people living with human immunodeficiency virus (HIV) who are prescribed integrase strand transfer inhibitors (INSTIs). Mechanisms and risk factors are incompletely understood. METHODS We utilized 2 cohorts to study pharmacogenetics of weight gain following switch from efavirenz- to INSTI-based regimens. In an observational cohort, we studied weight gain at 48 weeks following switch from efavirenz- to INSTI-based regimens among patients who had been virologically suppressed for at least 2 years at a clinic in the United States. Associations were characterized with CYP2B6 and UGT1A1 genotypes that affect efavirenz and INSTI metabolism, respectively. In a clinical trials cohort, we studied weight gain at 48 weeks among treatment-naive participants who were randomized to receive efavirenz-containing regimens in AIDS Clinical Trials Group studies A5095, A5142, and A5202 and did not receive INSTIs. RESULTS In the observational cohort (n = 61), CYP2B6 slow metabolizers had greater weight gain after switch (P = .01). This was seen following switch to elvitegravir or raltegravir, but not dolutegravir. UGT1A1 genotype was not associated with weight gain. In the clinical trials cohort (n = 462), CYP2B6 slow metabolizers had lesser weight gain at week 48 among participants receiving efavirenz with tenofovir disoproxil fumarate (P = .001), but not those receiving efavirenz with abacavir (P = .65). Findings were consistent when stratified by race/ethnicity and by sex. CONCLUSIONS Among patients who switched from efavirenz- to INSTI-based therapy, CYP2B6 genotype was associated with weight gain, possibly reflecting withdrawal of the inhibitory effect of higher efavirenz concentrations on weight gain. The difference by concomitant nucleoside analogue is unexplained.
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Affiliation(s)
| | - Zinhle Cindi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Yuki Bradford
- Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Megan Turner
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jamison Norwood
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Rebecca Basham
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paxton Baker
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Todd Hulgan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric S Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Roy Gulick
- Weill Cornell Medicine, New York, New York, USA
| | | | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David W Haas
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Meharry Medical College, Nashville, Tennessee, USA
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45
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Contemporary antiretrovirals and body-mass index: a prospective study of the RESPOND cohort consortium. Lancet HIV 2021; 8:e711-e722. [PMID: 34555326 DOI: 10.1016/s2352-3018(21)00163-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight gain effects of individual antiretroviral drugs are not fully understood. We investigated associations between a prespecified clinically significant increase (>7%) in body-mass index (BMI) and contemporary antiretroviral use. METHODS The International Cohort Consortium of Infectious Diseases (RESPOND) is a prospective, multicohort collaboration, including data from 17 well established cohorts and over 29 000 people living with HIV. People with HIV under prospective follow-up from Jan 1, 2012, and older than 18 years were eligible for inclusion. Each cohort contributed a predefined minimum number of participants related to the size of the specific cohort (with a minimum of 1000 participants). Participants were required to have CD4 cell counts and HIV viral load measurement in the 12 months before or within 3 months after baseline. For all antiretroviral drugs received at or after RESPOND entry, changes from pre-antiretroviral BMI levels (baseline) were considered at each BMI measurement during antiretroviral treatment. We used logistic regression to identify individual antiretrovirals that were associated with first occurrence of a more than 7% increase in BMI from pre-antiretroviral BMI. We adjusted analyses for time on antiretrovirals, pre-antiretroviral BMI, demographics, geographical region, CD4 cell count, viral load, smoking status, and AIDS at baseline. RESULTS 14 703 people were included in this study, of whom 7863 (53·5%) had a more than 7% increase in BMI. Compared with lamivudine, use of dolutegravir (odds ratio [OR] 1·27, 95% CI 1·17-1·38), raltegravir (1·37, 1·20-1·56), and tenofovir alafenamide (1·38, 1·22-1·35) was significantly associated with a more than 7% BMI increase, as was low pre-antiretroviral BMI (2·10, 1·91-2·31 for underweight vs healthy weight) and Black ethnicity (1·61, 1·47-1·76 vs White ethnicity). Higher CD4 count was associated with a reduced risk of BMI increase (0·97, 0·96-0·98 per 100 cells per μL increase). Relative to lamivudine, dolutegravir without tenofovir alafenamide (OR 1·21, 95% CI 1·19-1·32) and tenofovir alafenamide without dolutegravir (1·33, 1·15-1·53) remained independently associated with a more than 7% increase in BMI; the associations were higher when dolutegravir and tenofovir alafenamide were used concomitantly (1·79, 1·52-2·11, and 1·70, 1·44-2·01, respectively). INTERPRETATION Clinicians and people with HIV should be aware of associations between weight gain and use of dolutegravir, tenofovir alafenamide, and raltegravir, particularly given the potential consequences of weight gain, such as insulin resistance, dyslipidaemia, and hypertension. FUNDING The CHU St Pierre Brussels HIV Cohort, The Austrian HIV Cohort Study, The Australian HIV Observational Database, The AIDS Therapy Evaluation in the Netherlands national observational HIV cohort, The EuroSIDA cohort, The Frankfurt HIV Cohort Study, The Georgian National AIDS Health Information System, The Nice HIV Cohort, The ICONA Foundation, The Modena HIV Cohort, The PISCIS Cohort Study, The Swiss HIV Cohort Study, The Swedish InfCare HIV Cohort, The Royal Free HIV Cohort Study, The San Raffaele Scientific Institute, The University Hospital Bonn HIV Cohort and The University of Cologne HIV Cohorts, ViiV Healthcare, and Gilead Sciences.
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Edwards JK, Cole SR, Breger TL, Rudolph JE, Filiatreau LM, Buchacz K, Humes E, Rebeiro PF, D'Souza G, Gill MJ, Silverberg MJ, Mathews WC, Horberg MA, Thorne J, Hall HI, Justice A, Marconi VC, Lima VD, Bosch RJ, Sterling TR, Althoff KN, Moore RD, Saag M, Eron JJ. Mortality Among Persons Entering HIV Care Compared With the General U.S. Population : An Observational Study. Ann Intern Med 2021; 174:1197-1206. [PMID: 34224262 PMCID: PMC8453103 DOI: 10.7326/m21-0065] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Understanding advances in the care and treatment of adults with HIV as well as remaining gaps requires comparing differences in mortality between persons entering care for HIV and the general population. OBJECTIVE To assess the extent to which mortality among persons entering HIV care in the United States is elevated over mortality among matched persons in the general U.S. population and trends in this difference over time. DESIGN Observational cohort study. SETTING Thirteen sites from the U.S. North American AIDS Cohort Collaboration on Research and Design. PARTICIPANTS 82 766 adults entering HIV clinical care between 1999 and 2017 and a subset of the U.S. population matched on calendar time, age, sex, race/ethnicity, and county using U.S. mortality and population data compiled by the National Center for Health Statistics. MEASUREMENTS Five-year all-cause mortality, estimated using the Kaplan-Meier estimator of the survival function. RESULTS Overall 5-year mortality among persons entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017. LIMITATION Matching on available covariates may have failed to account for differences in mortality that were due to sociodemographic factors rather than consequences of HIV infection and other modifiable factors. CONCLUSION Mortality among persons entering HIV care decreased dramatically between 1999 and 2017, although those entering care remained at modestly higher risk for death in the years after starting care than comparable persons in the general U.S. population. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Jessie K Edwards
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | - Stephen R Cole
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | - Tiffany L Breger
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | | | - Lindsey M Filiatreau
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | - Kate Buchacz
- Centers for Disease Control and Prevention, Atlanta, Georgia (K.B., H.I.H.)
| | - Elizabeth Humes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.)
| | - Peter F Rebeiro
- Vanderbilt University School of Medicine, Nashville, Tennessee (P.F.R.)
| | - Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.)
| | - M John Gill
- University of Calgary, Calgary, Alberta, Canada (M.J.G.)
| | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland (M.A.H.)
| | - Jennifer Thorne
- Johns Hopkins University, Baltimore, Maryland (J.T., R.D.M.)
| | - H Irene Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (K.B., H.I.H.)
| | - Amy Justice
- Yale School of Public Health, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (A.J.)
| | | | - Viviane D Lima
- University of British Columbia, Vancouver, British Columbia, Canada (V.D.L.)
| | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (R.J.B.)
| | | | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.)
| | - Richard D Moore
- Johns Hopkins University, Baltimore, Maryland (J.T., R.D.M.)
| | - Michael Saag
- University of Alabama at Birmingham, Birmingham, Alabama (M.S.)
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
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Sjaarda A, Bernstein A, Sparks A, Saber S, Siegel M. Comparison of weight gain after antiretroviral switch to integrase strand transfer inhibitor or tenofovir alafenamide-based therapy. Infection 2021; 50:407-412. [PMID: 34449049 DOI: 10.1007/s15010-021-01687-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Several studies have reported weight gain after switching to integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART). Debate persists if weight gain also occurs when switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-based ART. METHODS We performed a retrospective chart review of virally suppressed HIV-infected patients who were switched from non INSTI- to INSTI-based ART (INSTI switch group) as well as patients switched from TDF- to TAF-based ART (TAF switch group), and compared the mean weight change in these groups to the mean change in weight in patients maintained on NNRTI-based regimens (control group). RESULTS 329 patients were identified. 256 patients in the INSTI switch group gained a mean 2.4 kg over 17 months compared to 0.5 kg in 54 patients in the control group over the same period (p = 0.008). 161 patients in the TAF switch group gained a mean 2.8 kg over 17 months compared to 0.5 kg in the control group (p = 0.003). There was no statistical difference in weight gain between the INSTI and TAF switch groups. Although the highest mean weight gain of 3.2 kg was seen in those 90 patients switched from both TDF- to TAF-based and non INSTI- to INSTI-based ART (TAF/INSTI switch group), this weight gain was not statistically different compared with the INSTI switch or TAF switch groups. CONCLUSION Our study suggests that weight gain is associated with both switching HIV regimens from non INSTI- to INSTI-based ART and TDF- to TAF-based ART.
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Affiliation(s)
- Alexandra Sjaarda
- The George Washington School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, USA
| | - Andrew Bernstein
- The George Washington School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, USA
| | - Andrew Sparks
- Department of Medicine, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Avenue, NW, Washington, DC, USA
| | - Saghar Saber
- St. John's Well Child and Family Center, 808 W 58th St, Los Angeles, CA, USA
| | - Marc Siegel
- Department of Medicine, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Avenue, NW, Washington, DC, USA. .,Division of Infectious Disease, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-436, Washington, DC, 20037, USA.
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48
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Abstract
PURPOSE OF REVIEW A growing body of evidence suggests that integrase inhibitors (INSTIs) are significantly associated with weight gain and obesity. Obesity is a significant risk factor for metabolic syndrome and diabetes. This article comprehensively reviews recent available evidence weight gain and the risks of metabolic syndrome and diabetes associated with INSTIs. RECENT FINDINGS Recent evidence continues to contribute to the evidence for weight gain associated with INSTIs, especially when used with newer nucleoside reverse transcriptase inhibitor, tenofovir alafenamide (TAF). Although the literature suggests a neutral effect on lipids, there is evidence that INSTIs are associated with metabolic syndrome due to treatment-emergent obesity. The literature for short-term treatment-emergent diabetes and insulin resistance remains inconsistent, but there is some evidence that weight gain could lead to an increased risk of developing diabetes in the future. SUMMARY Longer term studies are required to understand the metabolic impact of INSTIs, secondary to weight gain. Evidence suggests that INSTIs, when used with TAF, contribute to metabolic syndrome and may have long-term risks of diabetes. INSTIs, when used with tenofovir disoproxil fumarate, have fewer metabolic implications. Clinicians must monitor for weight gain and metabolic effects, especially in those with underlying risk factors.
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Nissim O, Lazenby GB. The Use of Integrase Strand Transfer Inhibitors to Treat HIV in Pregnancy. J Midwifery Womens Health 2021; 66:403-406. [PMID: 34166578 DOI: 10.1111/jmwh.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
For pregnant women with HIV, antiretroviral therapy (ART) plays a key role in prevention of perinatal transmission. Newer antiretroviral regimens now contain integrase strand transfer inhibitors, which have been found to rapidly suppress HIV viral load in nonpregnant women; however, there are limited data for use in pregnancy. Here, we present the case of a pregnant woman with well-controlled HIV on a well-tolerated prepregnancy regimen of bictegravir, emtricitabine, and tenofovir alafenamide. As there are limited safety data on bictegravir in pregnancy, this ART regimen was changed to a preferred regimen for pregnancy. In the second trimester, because of adverse effects from the new ART regimen and after a risk-benefit discussion, the patient restarted the original regimen. She was able to maintain viral suppression until giving birth.
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Affiliation(s)
- Oriel Nissim
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
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50
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Lopez-Alvarenga JC, Martinez DA, Diaz-Badillo A, Morales LD, Arya R, Jenkinson CP, Curran JE, Lehman DM, Blangero J, Duggirala R, Mummidi S, Martinez RD. Association of HIV-1 Infection and Antiretroviral Therapy With Type 2 Diabetes in the Hispanic Population of the Rio Grande Valley, Texas, USA. Front Med (Lausanne) 2021; 8:676979. [PMID: 34291061 PMCID: PMC8287129 DOI: 10.3389/fmed.2021.676979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022] Open
Abstract
The Rio Grande Valley (RGV) in South Texas has one of the highest prevalence of obesity and type 2 diabetes (T2D) in the United States (US). We report for the first time the T2D prevalence in persons with HIV (PWH) in the RGV and the interrelationship between T2D, cardiometabolic risk factors, HIV-related indices, and antiretroviral therapies (ART). The PWH in this study received medical care at Valley AIDS Council (VAC) clinic sites located in Harlingen and McAllen, Texas. Henceforth, this cohort will be referred to as Valley AIDS Council Cohort (VACC). Cross-sectional analyses were conducted using retrospective data obtained from 1,827 registries. It included demographic and anthropometric variables, cardiometabolic traits, and HIV-related virological and immunological indices. For descriptive statistics, we used mean values of the quantitative variables from unbalanced visits across 20 months. Robust regression methods were used to determine the associations. For comparisons, we used cardiometabolic trait data obtained from HIV-uninfected San Antonio Mexican American Family Studies (SAMAFS; N = 2,498), and the Mexican American population in the National Health and Nutrition Examination Survey (HHANES; N = 5,989). The prevalence of T2D in VACC was 51% compared to 27% in SAMAFS and 19% in HHANES, respectively. The PWH with T2D in VACC were younger (4.7 years) and had lower BMI (BMI 2.43 units less) when compared to SAMAFS individuals. In contrast, VACC individuals had increased blood pressure and dyslipidemia. The increased T2D prevalence in VACC was independent of BMI. Within the VACC, ART was associated with viral load and CD4+ T cell counts but not with metabolic dysfunction. Notably, we found that individuals with any INSTI combination had higher T2D risk: OR 2.08 (95%CI 1.67, 2.6; p < 0.001). In summary, our results suggest that VACC individuals may develop T2D at younger ages independent of obesity. The high burden of T2D in these individuals necessitates rigorously designed longitudinal studies to draw potential causal inferences and develop better treatment regimens.
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Affiliation(s)
- Juan Carlos Lopez-Alvarenga
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | | | - Alvaro Diaz-Badillo
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Liza D. Morales
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Rector Arya
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Christopher P. Jenkinson
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Joanne E. Curran
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Donna M. Lehman
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - John Blangero
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Ravindranath Duggirala
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Srinivas Mummidi
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
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