Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2020 Dec 3;71(9):e471-e477. doi: 10.1093/cid/ciaa177.
Treatment initiation with integrase strand transfer inhibitors (INSTIs) has been associated with excess weight gain. Whether similar gains are seen after switch to INSTIs among virologically suppressed persons is less clear. We assessed pre/post-INSTI weight changes from AIDS Clinical Trials Group participants (A5001 and A5322).
Participants who were in follow-up from 1997-2017 and switched to INSTI-based antiretroviral regimens were included. Piecewise linear mixed-effects models adjusting for age, sex, race/ethnicity, baseline BMI, nadir and current CD4+ T-cell count, smoking, diabetes and follow-up time with suppressed HIV-1 RNA examined weight and waist circumference change before and after first switch to INSTIs. Linear spline models with a single knot at time of switch accounted for nonlinear trends.
The 972 participants who switched to INSTIs were 81% male and 50% nonwhite with a median age at switch of 50 years, CD4+ T-cell count 512 cells/μL, and BMI 26.4 kg/m2. Restricting to persons with suppressed HIV-1 RNA at switch (n = 691), women, blacks, and persons ≥60 years experienced greater weight gain in the 2 years after versus before switch. In adjusted models, white or black race, age ≥60, and BMI ≥30 kg/m2 at switch were associated with greater weight gain following switch among women; age ≥60 was the greatest risk factor among men. Trends for waist circumference were similar.
Yearly weight gain increased following switch to INSTIs, particularly for women, blacks, and persons aged ≥60. Concomitant increases in waist circumference suggest that this weight gain is associated with an increase in fat mass.
整合酶链转移抑制剂（INSTIs）的治疗起始与体重增加有关。在病毒学抑制的人群中，改用 INSTIs 是否会出现类似的体重增加尚不清楚。我们评估了 AIDS 临床试验组（A5001 和 A5322）参与者在改用 INSTIs 前后的体重变化。
纳入了在 1997-2017 年期间进行随访并改用基于 INSTI 的抗逆转录病毒治疗方案的参与者。调整年龄、性别、种族/民族、基线 BMI、最低点和当前 CD4+T 细胞计数、吸烟、糖尿病和 HIV-1 RNA 抑制随访时间的分段线性混合效应模型，检查了首次改用 INSTIs 前后的体重和腰围变化。在转换时使用单个结的线性样条模型来解释非线性趋势。
972 名改用 INSTIs 的参与者中，81%为男性，50%为非裔美国人，平均年龄为 50 岁，CD4+T 细胞计数为 512 个/μL，BMI 为 26.4 kg/m2。将 HIV-1 RNA 抑制的参与者限制在切换时（n=691），女性、黑人以及年龄≥60 岁的人在切换后 2 年内体重增加更多。在调整模型中，白种人或黑种人、年龄≥60 岁以及切换时 BMI≥30 kg/m2 与女性改用 INSTIs 后体重增加有关；年龄≥60 岁是男性的最大危险因素。腰围的趋势相似。
改用 INSTIs 后，体重每年都在增加，尤其是女性、黑人以及年龄≥60 岁的人。腰围的同时增加表明体重增加与脂肪量的增加有关。
