Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital St Antoine, F75012, Paris, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France.
J Antimicrob Chemother. 2023 Mar 2;78(3):757-768. doi: 10.1093/jac/dkad007.
Many studies have reported weight gain in ART-naive people living with HIV (PWH) initiating an integrase strand-transfer inhibitor-based regimen. We studied the impact of early or advanced presentation and that of individual drugs in PWH initiating combined ART (cART) between 2012 and 2018.
From the French Hospital Database HIV cohort, we assessed factors associated with a weight gain ≥10%, weight change after cART initiation or BMI increase ≥5 kg/m2 up to 30 months. The analyses were conducted overall, and among PWH with early (primary infection or CD4 >350/mm3 and viral load <100 000 copies/mL, without AIDS) and advanced presentation (AIDS or CD4 <200/mm3, not during primary infection).
At 30 months, 34.5% (95% CI: 33.5-35.6) of the 12 773 PWH had a weight gain ≥10%, with 20.9% (95% CI: 19.6-22.2) among the 5794 with early presentation and 63.1% (95% CI: 60.9-65.3) among the 3106 with advanced presentation. Weight gain was 2.8 kg (95% CI: 2.0-3.7) for those with early presentation and 9.7 kg (95% CI: 8.4-11.1) for those with advanced presentation. Most weight gain occurred in the first 12 months. Underweight and obese PWH were at significantly higher risk of a BMI increase ≥5 kg/m2 than normal-weight PWH. Results differed within classes and by outcome. Raltegravir and dolutegravir were consistently associated with greater weight gain than the other third agents. Tenofovir alafenamide was also associated with higher weight gain than tenofovir disoproxil or abacavir.
After initiating cART, PWH with early presentation exhibited a small weight gain, whereas it was large among those with advanced presentation. The choice of ART should account for the risk of weight gain, especially for PWH who present with advanced disease and/or are obese.
许多研究报告称，在开始整合酶抑制剂为基础的方案治疗的初治 HIV 感染者（PWH）中，体重会增加。我们研究了在 2012 年至 2018 年期间，初治和晚期就诊以及个体药物对 PWH 开始联合抗逆转录病毒治疗（cART）后体重增加≥10%、cART 起始后体重变化或 BMI 增加≥5kg/m2 的影响。
我们从法国医院数据库 HIV 队列中评估了与体重增加≥10%、cART 起始后体重变化或 BMI 增加≥5kg/m2 相关的因素，直到 30 个月。分析总体进行，并在初治（原发性感染或 CD4>350/mm3 和病毒载量<100,000 拷贝/ml，无艾滋病）和晚期（艾滋病或 CD4<200/mm3，非原发性感染）就诊的 PWH 中进行。
在 30 个月时，12773 名 PWH 中有 34.5%（95%CI：33.5-35.6）体重增加≥10%，其中 5794 名初治患者中有 20.9%（95%CI：19.6-22.2），3106 名晚期就诊患者中有 63.1%（95%CI：60.9-65.3）。初治患者体重增加 2.8kg（95%CI：2.0-3.7），晚期就诊患者体重增加 9.7kg（95%CI：8.4-11.1）。大多数体重增加发生在最初的 12 个月。与体重正常的 PWH 相比，体重过轻和肥胖的 PWH 发生 BMI 增加≥5kg/m2 的风险显著更高。结果在不同类别和结果中存在差异。拉替拉韦和多替拉韦比其他第三类药物更易导致体重增加。替诺福韦艾拉酚胺也比替诺福韦酯或阿巴卡韦更容易导致体重增加。
开始 cART 后，初治患者体重增加较小，而晚期就诊患者体重增加较大。ART 的选择应考虑体重增加的风险，尤其是对于晚期就诊和/或肥胖的 PWH。
