Rolle Charlotte-Paige, Garrett Jeffrey, Castano Jamie, Nguyen Vu, Patel Kiran, Hinestrosa Federico, DeJesus Edwin
Orlando Immunology Center, Orlando, FL.
Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA.
Medicine (Baltimore). 2025 Mar 7;104(10):e41728. doi: 10.1097/MD.0000000000041728.
Increased weight has been observed among treatment-naïve-and-experienced people living with HIV initiating bictegravir (BIC) and dolutegravir (DTG). Here, we report changes in weight and body mass index (BMI) following switch to a BIC versus DTG-based regimen (DBR) through 144 weeks. This observational study collected demographics, clinical characteristics, weight, and BMI from virologically suppressed adults switched to BIC/emtricitabine/tenofovir alafenamide (TAF), emtricitabine/TAF plus DTG, DTG/abacavir/lamivudine, DTG/rilpivirine (RPV), and DTG/lamivudine 2 years prior to switch through 144 weeks post-switch. Linear spline models were fit to estimate and compare the trajectories of weight and BMI changes observed pre-and-post-switch. Adjusted piecewise linear mixed-effects models were fit to examine factors associated with weight and BMI change pre-and-post-switch. At week 144, switching to BIC/emtricitabine/TAF versus a DBR were both associated with lower annualized weight gain post-switch (-0.88 kg/year vs -0.39 kg/year respectively, P = .15). DTG plus emtricitabine/TAF switches had the highest annualized weight gain (0.68 kg/year, 95% confidence interval: -0.32, 1.65) whereas, DTG/RPV switches had the lowest annualized weight gain (-2.22 kg/year, 95% confidence interval: -3.69, -0.62) post-switch. DTG/RPV and BIC/emtricitabine/TAF switches were the only groups with significantly lower annualized weight gain post-switch at week 144. Baseline BMI < 18.5 kg/m2 was associated with the highest annualized weight gain post-switch, whereas switching from protease inhibitors and self-report of dieting were associated with the lowest annualized weight gain post-switch. At week 144, switching to a BIC versus DBR were both associated with lower annualized weight gain post-switch among a large and diverse cohort of treatment-experienced people living with HIV.
在初治和经治的HIV感染者中，开始使用比克替拉韦（BIC）和多替拉韦（DTG）后体重有所增加。在此，我们报告了转换为基于BIC与基于DTG的治疗方案（DBR）后144周内体重和体重指数（BMI）的变化。这项观察性研究收集了转换治疗前两年至转换治疗后144周期间病毒学抑制的成年人的人口统计学、临床特征、体重和BMI，这些成年人转换为BIC/恩曲他滨/替诺福韦艾拉酚胺（TAF）、恩曲他滨/TAF加DTG、DTG/阿巴卡韦/拉米夫定、DTG/利匹韦林（RPV）和DTG/拉米夫定。采用线性样条模型来估计和比较转换治疗前后观察到的体重和BMI变化轨迹。采用调整后的分段线性混合效应模型来研究与转换治疗前后体重和BMI变化相关的因素。在第144周时，转换为BIC/恩曲他滨/TAF与DBR均与转换治疗后较低的年化体重增加相关（分别为-0.88千克/年和-0.39千克/年，P = 0.15）。DTG加恩曲他滨/TAF的转换治疗年化体重增加最高（0.68千克/年，95%置信区间：-0.32，1.65），而DTG/RPV的转换治疗年化体重增加最低（-2.22千克/年，95%置信区间：-3.69，-0.62）。DTG/RPV和BIC/恩曲他滨/TAF的转换治疗是在第144周时转换治疗后年化体重增加显著较低的仅有的两组。基线BMI<18.5千克/平方米与转换治疗后最高的年化体重增加相关，而从蛋白酶抑制剂转换治疗和自我报告节食与转换治疗后最低的年化体重增加相关。在第144周时，在一大群多样化的有治疗经验的HIV感染者中，转换为BIC与DBR均与转换治疗后较低的年化体重增加相关。
