Tieosapjaroen Warittha, Chow Eric P F, Fairley Christopher K, Hoy Jennifer, Aguirre Ivette, Ong Jason J
Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia.
Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
AIDS Patient Care STDS. 2023 Mar;37(3):131-137. doi: 10.1089/apc.2022.0203. Epub 2023 Feb 21.
Further investigations into the relationship between integrase strand transfer inhibitors (INSTIs) and weight gain are required, especially whether ceasing INSTI results in weight loss. We evaluated weight changes associated with different antiretroviral (ARV) regimens. A retrospective longitudinal cohort study was conducted using data extracted from the electronic clinical database at the Melbourne Sexual Health Centre, Australia, from 2011 to 2021. The association between weight change per time unit and ARV use in people living with HIV (PLWH) and the factors associated with weight changes when using INSTIs were estimated using a generalized estimated equation model. We included 1540 PLWH contributing 7476 consultations and 4548 person-years of data. ARV-naive PLWH initiating INSTIs gained an average of 2.55 kg/year (95% confidence interval 0.56 to 4.54; = 0.012), while those using protease inhibitors and non-nucleoside reverse transcriptase inhibitors had no significant weight change. When switching off INSTIs, there was no significant weight change ( = 0.055). These weight changes were adjusted for age, gender, time on ARVs, and/or use of tenofovir alafenamide (TAF). Weight gain was the main reason PLWH ceased INSTIs. In addition, risk factors for weight gain in INSTI users were age younger than 60 years, male gender, and concomitant use of TAF. Weight gain was found among PLWH using INSTIs. After INSTI discontinuation, PLWH's weight stopped rising, but no weight loss was observed. Careful weight measurement after initiating INSTIs and early initiation of strategies to avoid weight gain will be important to prevent permanent weight gain and the associated morbidity.
需要进一步研究整合酶链转移抑制剂（INSTIs）与体重增加之间的关系，特别是停用INSTIs是否会导致体重减轻。我们评估了与不同抗逆转录病毒（ARV）方案相关的体重变化。利用从澳大利亚墨尔本性健康中心2011年至2021年的电子临床数据库中提取的数据进行了一项回顾性纵向队列研究。使用广义估计方程模型估计了艾滋病毒感染者（PLWH）每单位时间的体重变化与ARV使用之间的关联，以及使用INSTIs时与体重变化相关的因素。我们纳入了1540名PLWH，他们提供了7476次会诊和4548人年的数据。初治的PLWH开始使用INSTIs后平均每年体重增加2.55千克（95%置信区间为0.56至4.54；P = 0.012），而使用蛋白酶抑制剂和非核苷类逆转录酶抑制剂的患者体重没有显著变化。停用INSTIs时，体重没有显著变化（P = 0.055）。这些体重变化对年龄、性别、使用ARV的时间和/或替诺福韦艾拉酚胺（TAF）的使用进行了校正。体重增加是PLWH停用INSTIs的主要原因。此外，使用INSTIs的患者体重增加的危险因素包括年龄小于60岁、男性以及同时使用TAF。在使用INSTIs的PLWH中发现了体重增加的情况。停用INSTIs后，PLWH的体重停止上升，但未观察到体重减轻。开始使用INSTIs后仔细测量体重，并尽早启动避免体重增加的策略，对于预防永久性体重增加及相关疾病将很重要。
