Back to Search Start Over

Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials.

Authors :
Sax, Paul E
Erlandson, Kristine M
Lake, Jordan E
Mccomsey, Grace A
Orkin, Chloe
Esser, Stefan
Brown, Todd T
Rockstroh, Jürgen K
Wei, Xuelian
Carter, Christoph C
Zhong, Lijie
Brainard, Diana M
Melbourne, Kathleen
Das, Moupali
Stellbrink, Hans-Jürgen
Post, Frank A
Waters, Laura
Koethe, John R
Source :
Clinical Infectious Diseases; 9/15/2020, Vol. 71 Issue 6, p1379-1389, 11p
Publication Year :
2020

Abstract

Background Initiation of antiretroviral therapy (ART) often leads to weight gain. While some of this weight gain may be an appropriate return-to-health effect, excessive increases in weight may lead to obesity. We sought to explore factors associated with weight gain in several randomized comparative clinical trials of ART initiation. Methods We performed a pooled analysis of weight gain in 8 randomized controlled clinical trials of treatment-naive people living with human immunodeficiency virus (HIV) initiating ART between 2003 and 2015, comprising >5000 participants and 10 000 person-years of follow-up. We used multivariate modeling to explore relationships between demographic factors, HIV disease characteristics, and ART components and weight change following ART initiation. Results Weight gain was greater in more recent trials and with the use of newer ART regimens. Pooled analysis revealed baseline demographic factors associated with weight gain including lower CD4 cell count, higher HIV type 1 RNA, no injection drug use, female sex, and black race. Integrase strand transfer inhibitor use was associated with more weight gain than were protease inhibitors or nonnucleoside reverse transcriptase inhibitors (NNRTIs), with dolutegravir and bictegravir associated with more weight gain than elvitegravir/cobicistat. Among the NNRTIs, rilpivirine was associated with more weight gain than efavirenz. Among nucleoside/nucleotide reverse transcriptase inhibitors, tenofovir alafenamide was associated with more weight gain than tenofovir disoproxil fumarate, abacavir, or zidovudine. Conclusions Weight gain is ubiquitous in clinical trials of ART initiation and is multifactorial in nature, with demographic factors, HIV-related factors, and the composition of ART regimens as contributors. The mechanisms by which certain ART agents differentially contribute to weight gain are unknown. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10584838
Volume :
71
Issue :
6
Database :
Complementary Index
Journal :
Clinical Infectious Diseases
Publication Type :
Academic Journal
Accession number :
145718485
Full Text :
https://doi.org/10.1093/cid/ciz999