Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina.
University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Curr Opin Infect Dis. 2020 Feb;33(1):10-19. doi: 10.1097/QCO.0000000000000616.
Weight gain and obesity among people living with HIV (PLWH) is a serious problem that occurs often after initiation of antiretroviral therapy but may be worse with integrase strand transfer inhibitors (INSTIs). This article comprehensively reviews available data and summarizes our current understanding of the topic.
Recent studies support the concept that weight gain and treatment emergent obesity are worse with INSTI-based regimens, particularly dolutegravir. Women and nonwhites appear to be the most at risk, and the accompanying nucleoside reverse transcriptase inhibitor may play a role. Lipohypertrophy, an abnormal accumulation of visceral fat and/or ectopic fat depots, continues to be a problem among PLWH, but the role of INSTIs is inconsistent. The pathogenesis of weight gain and changes in body composition in HIV, especially with INSTIs, is poorly understood but may lead to serious comorbidities, such as cardiovascular disease and diabetes.
Although INSTI-based regimens are highly efficacious for viral suppression, they appear to cause more weight gain and treatment emergent obesity than non-INSTI-based regimens and may increase the risk of weight-related comorbidities. More studies are needed to understand the pathogenesis of weight gain with INSTIs in PLWH, in order to prevent this serious complication.
抗逆转录病毒治疗（ART）开始后，HIV 感染者（PLWH）体重增加和肥胖是一个严重的问题，但整合酶抑制剂（INSTIs）可能会使问题恶化。本文全面回顾了现有数据，总结了我们目前对这一主题的理解。
最近的研究支持了这样一种概念，即 INSTI 为基础的治疗方案，尤其是多替拉韦，会导致体重增加和治疗后肥胖的风险增加。女性和非白人似乎风险最高，伴随的核苷逆转录酶抑制剂可能起作用。脂肪代谢障碍，即内脏脂肪和/或异位脂肪堆积异常，仍是 PLWH 的一个问题，但 INSTIs 的作用并不一致。HIV 中体重增加和身体成分变化的发病机制，特别是与 INSTIs 相关的机制，尚不清楚，但可能导致严重的合并症，如心血管疾病和糖尿病。
尽管 INSTI 为基础的治疗方案在病毒抑制方面非常有效，但与非 INSTI 为基础的治疗方案相比，它们似乎会导致更多的体重增加和治疗后肥胖，并可能增加与体重相关的合并症的风险。需要进一步研究来了解 INSTIs 在 PLWH 中导致体重增加的发病机制，以预防这一严重并发症。
