University of Washington, Seattle, WA.
Department of Medicine, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2021 Mar 1;86(3):339-343. doi: 10.1097/QAI.0000000000002556.
OBJECTIVES: Evaluate differences in weight change by regimen among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in the current era. METHODS: Between 2012 and 2019, 3232 ART-naïve PLWH initiated ≥3-drug ART regimens in 8 Centers for AIDS Research Network of Integrated Clinical Systems sites. We estimated weight change by regimen for 11 regimens in the immediate (first 6 months) and extended (all follow-up on initial regimen) periods using linear mixed models adjusted for time on regimen, interaction between time and regimen, age, sex, race/ethnicity, hepatitis B/C coinfection, nadir CD4, smoking, diabetes, antipsychotic medication, and site. We included more recently approved regimens [eg, with tenofovir alafenamide fumarate (TAF)] only in the immediate period analyses to ensure comparable follow-up time. RESULTS: Mean follow-up was 1.9 years on initial ART regimen. In comparison to efavirenz/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), initiating bictegravir/TAF/FTC {3.9 kg [95% confidence interval (CI): 2.2 to 5.5]} and dolutegravir/TAF/FTC [4.4 kg (95% CI: 2.1 to 6.6)] were associated with the greatest weight gain in the immediate period, followed by darunavir/TDF/FTC [3.7 kg (95% CI: 2.1 to 5.2)] and dolutegravir/TDF/FTC [2.6 kg (95% CI: 1.3 to 3.9)]. In the extended period, compared with efavirenz/TDF/FTC, initiating darunavir/TDF/FTC was associated with a 1.0 kg (95% CI: 0.5 to 1.5) per 6-months greater weight gain, whereas dolutegravir/abacavir/FTC was associated with a 0.6-kg (95% CI: 0.3 to 0.9) and dolutegravir/TDF/FTC was associated with a 0.6-kg (95% CI: 0.1 to 1.1) per 6-months greater gain. Weight gain on dolutegravir/abacavir/FTC and darunavir/TDF/FTC was significantly greater than that for several integrase inhibitor-based regimens. CONCLUSIONS: There is heterogeneity between regimens in weight gain following ART initiation among previously ART-naïve PLWH; we observed greater gain among PLWH taking newer integrase strand transfer inhibitors (DTG, BIC) and DRV-based regimens.
目的：评估当前时代接受抗逆转录病毒疗法（ART）的艾滋病毒（HIV）感染者（PLWH）在开始治疗时，不同治疗方案对体重变化的影响。
方法：在 2012 年至 2019 年间，8 个艾滋病研究网络综合临床系统中心的 3232 名初始抗逆转录病毒治疗（ART）的 PLWH 开始接受至少 3 种药物的 ART 方案。我们使用线性混合模型，根据方案时间、方案时间与交互作用、年龄、性别、种族/民族、乙型肝炎/丙型肝炎合并感染、CD4 最低点、吸烟、糖尿病、抗精神病药物和地点，对 11 种方案在立即（前 6 个月）和扩展（初始方案的所有后续）期间的体重变化进行了估计。我们仅将最近批准的方案（如含有富马酸替诺福韦艾拉酚胺[TAF]的方案）纳入立即期分析，以确保可比的随访时间。
结果：初始 ART 方案的平均随访时间为 1.9 年。与依非韦伦/替诺福韦二吡呋酯（TDF）/恩曲他滨（FTC）相比，接受比克替拉韦/TAF/FTC[3.9kg（95%置信区间：2.2 至 5.5）]和度鲁特韦/TAF/FTC[4.4kg（95%置信区间：2.1 至 6.6）]治疗的患者在立即期体重增加最多，其次是达芦那韦/TDF/FTC[3.7kg（95%置信区间：2.1 至 5.2）]和度鲁特韦/TDF/FTC[2.6kg（95%置信区间：1.3 至 3.9）]。在扩展期，与依非韦伦/TDF/FTC 相比，开始使用达芦那韦/TDF/FTC 治疗的患者每 6 个月体重增加 1.0kg（95%置信区间：0.5 至 1.5），而接受度鲁特韦/阿巴卡韦/FTC 治疗的患者体重增加 0.6kg（95%置信区间：0.3 至 0.9），接受度鲁特韦/TDF/FTC 治疗的患者体重增加 0.6kg（95%置信区间：0.1 至 1.1）。接受度鲁特韦/阿巴卡韦/FTC 和达芦那韦/TDF/FTC 治疗的患者体重增加明显大于几种整合酶抑制剂为基础的方案。
结论：在先前未接受 ART 的 PLWH 中，ART 开始后体重增加存在方案间的异质性；我们观察到，接受新型整合酶链转移抑制剂（DTG、BIC）和基于 DRV 的方案的 PLWH 体重增加更多。
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