Department of Infectious diseases, Grand Hôpital de Charleroi, Charleroi, Belgium.
Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
AIDS Rev. 2023;25(1):54-64. doi: 10.24875/AIDSRev.22000026.
The risk of developing non-AIDS events (NAEs) remains higher in persons living with HIV-1 (PLWH) compared to the general population despite progress made in the treatment by antiretroviral (ARV). Particular attention is therefore given to the management of risk factors associated with NAEs during the follow-up of PLWH, including overweight. Factors associated with weight gain in PLWH are multifactorial and include demographics, HIV disease-related, lifestyle, cultural, and antiretroviral therapy (ART)-associated factors. All these confounding factors make it difficult to interpret the potential link between ARVs and weight gain. In antiretroviral treatment- experienced PLWH, confounding factors such as the return to normal health or the advanced stage of disease can be ruled out compared to naïve patients which somewhat facilitates the interpretation of weight gain. Weight gain after ART switch is modest, not generally a big concern in clinical practice in this population and correlated more strongly with baseline regimen, especially after the stop of TDF or EFV, than with sex-, race-, or HIV-related factors. It remains uncertain whether this is due to the loss of a weight suppressive effect of prior regimens with older agent such as TDF or EFV or a weight gain effect of the newer regimens especially TAF and/or INSTI, or both. The mechanisms linked to weight gain attributed to the new ARVs as well as its possible reversibility are not yet elucidated. Clinicians who switched ARV regimen of experienced PLWH should be aware of this side effect and of this potentially consequences on the global health.
尽管抗逆转录病毒 (ARV) 治疗取得了进展，但与普通人群相比，HIV-1 感染者 (PLWH) 发生非艾滋病事件 (NAE) 的风险仍然更高。因此，在 PLWH 的随访中，特别关注与 NAE 相关的危险因素的管理，包括超重。PLWH 体重增加的相关因素是多因素的，包括人口统计学、HIV 疾病相关、生活方式、文化和抗逆转录病毒治疗 (ART) 相关因素。所有这些混杂因素使得解释 ARV 与体重增加之间的潜在联系变得困难。在接受过抗逆转录病毒治疗的 PLWH 中，可以排除与未接受过治疗的患者相比，回归正常健康或疾病晚期等混杂因素，这在一定程度上有助于解释体重增加的问题。ART 转换后的体重增加是适度的，在该人群的临床实践中通常不是一个大问题，与基线方案的相关性更强，尤其是在停止 TDF 或 EFV 后，而与性别、种族或 HIV 相关因素的相关性较弱。目前尚不确定这是由于先前方案中使用 TDF 或 EFV 等较老药物导致体重抑制作用丧失，还是由于新方案（尤其是 TAF 和/或 INSTI）的体重增加作用，或者两者都有。与新的 ARV 相关的体重增加机制及其可能的可逆性尚未阐明。转换过 ARV 方案的经验丰富的 PLWH 临床医生应该意识到这种副作用及其对全球健康的潜在影响。
