Norwood Jamison, Turner Megan, Bofill Carmen, Rebeiro Peter, Shepherd Bryan, Bebawy Sally, Hulgan Todd, Raffanti Stephen, Haas David W, Sterling Timothy R, Koethe John R
*Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; †Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN; ‡Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; and §Department of Medicine, Meharry Medical College, Nashville, TN.
J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):527-531. doi: 10.1097/QAI.0000000000001525.
With the introduction of integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy, persons living with HIV have a potent new treatment option. Recently, providers at our large treatment clinic noted weight gain in several patients who switched from efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) to dolutegravir/abacavir/lamivudine (DTG/ABC/3TC). In this study, we evaluated weight change in patients with sustained virologic suppression who switched from EFV/TDF/FTC to an INSTI-containing regimen.
We performed a retrospective observational cohort study among adults on EFV/TDF/FTC for at least 2 years who had virologic suppression. We assessed weight change over 18 months in patients who switched from EFV/TDF/FTC to an INSTI-containing regimen or a protease inhibitor (PI)-containing regimen versus those on EFV/TDF/FTC over the same period. In a subgroup analysis, we compared patients switched to DTG/ABC/3TC versus raltegravir- or elvitegravir-containing regimens.
A total of 495 patients were included: 136 who switched from EFV/TDF/FTC to an INSTI-containing regimen and 34 switched to a PI-containing regimen. Patients switched to an INSTI-containing regimen gained an average of 2.9 kg at 18 months compared with 0.9 kg among those continued on EFV/TDF/FTC (P = 0.003), whereas those switched to a PI regimen gained 0.7 kg (P = 0.81). Among INSTI regimens, those switched to DTG/ABC/3TC gained the most weight at 18 months (5.3 kg, P = 0.001 compared with EFV/TDF/FTC).
Adults living with HIV with viral suppression gained significantly more weight after switching from daily, fixed-dose EFV/TDF/FTC to an INSTI-based regimen compared with those remaining on EFV/TDF/FTC. This weight gain was greatest among patients switching to DTG/ABC/3TC.
随着基于整合酶链转移抑制剂（INSTI）的抗逆转录病毒疗法的引入，HIV感染者有了一种有效的新治疗选择。最近，我们大型治疗诊所的医护人员注意到，几名从依非韦伦/替诺福韦酯/恩曲他滨（EFV/TDF/FTC）转换为多替拉韦/阿巴卡韦/拉米夫定（DTG/ABC/3TC）的患者体重增加。在本研究中，我们评估了从EFV/TDF/FTC转换为含INSTI方案的病毒学持续抑制患者的体重变化。
我们对接受EFV/TDF/FTC治疗至少2年且病毒学抑制的成年人进行了一项回顾性观察队列研究。我们评估了从EFV/TDF/FTC转换为含INSTI方案或含蛋白酶抑制剂（PI）方案的患者在18个月内的体重变化，并与同期继续使用EFV/TDF/FTC的患者进行比较。在亚组分析中，我们比较了转换为DTG/ABC/3TC的患者与转换为含拉替拉韦或埃替格韦方案的患者。
共纳入495例患者：136例从EFV/TDF/FTC转换为含INSTI方案，34例转换为含PI方案。转换为含INSTI方案的患者在18个月时平均体重增加2.9 kg，而继续使用EFV/TDF/FTC的患者体重增加0.9 kg（P = 0.003），而转换为PI方案的患者体重增加0.7 kg（P = 0.81）。在INSTI方案中，转换为DTG/ABC/3TC的患者在18个月时体重增加最多（5.3 kg，与EFV/TDF/FTC相比，P = 0.001）。
与继续使用EFV/TDF/FTC的HIV感染者相比，病毒学抑制的成年HIV感染者从每日固定剂量的EFV/TDF/FTC转换为基于INSTI的方案后体重增加明显更多。转换为DTG/ABC/3TC的患者体重增加最为显著。
