HIV integrase strand transfer inhibitors (INSTI) are considered well tolerated with few treatment-limiting adverse effects. However, emerging data from clinical trials has identified excessive weight gain possibly due to INSTI alone or with tenofovir alafenamide as a new and possible long-term complication of combination antiretroviral therapy (cART). Identifying who is at greatest risk and whether the unintended weight gain is reversible remain unanswered questions. We report a return to baseline weight after switching back to tenofovir disoproxil/emtricitabine/efavirenz (Atripla®) in a woman who had profound weight gain due to tenofovir alafenamide/emtricitabine/cobicistat/elvitegravir (Genvoya®).
YuhBTateJButtAA, et al. Weight change after antiretroviral therapy and mortality. Clin Infect Dis2015; 60(12): 1852–1859.
2.
EckardARMcComseyGA.Weight gain and integrase inhibitors. Curr Opin Infect Dis2020; 33(1): 10–19.
3.
SaxPEErlandsonKMLakeJE, et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis 2020; 71(6): 1379–1389.
4.
SchaferJJSassaKNO’ConnorJR, et al. Changes in body mass index and atherosclerotic disease risk score after switching from tenofovir disoproxil fumarate to tenofovir alafenamide. Open Forum Infect Dis2019; 6(10): ofz414. DOI: 10.1093/ofid/ofz414.
5.
NorwoodJTurnerMBofillC, et al. Weight gain in persons with HIV switched from efavirenz-based to integrase strand transfer inhibitor-based regimens. J Acquir Immune Defic Syndr2017; 76(5): 527–531.
6.
KouanfackCMpoudi-EtameMBassegaPO, et al.; NAMSAL ANRS 12313 Study Group.Dolutegravir-based or low -dose efavirenz-based regimen for the treatment of HIV-1. N Eng J Med 2019; 381(9): 816–826.
7.
VenterWDFMoorhouseMSokhelaS, et al. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med2019; 381(9): 803–815.
8.
LichtensteinKAWardDJMoormanAC, et al. Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS2001; 15(11): 1389–1398.
9.
SafrinSGrunfeldC.Fat distribution and metabolic changes in patients with HIV infection. AIDS1999; 13(18): 2493–2505.
10.
MoyleGMoutschenMMartinezE, et al. Epidemiology, assessment, and management of excess abdominal fat in persons with HIV infection. AIDS Rev2010; 12(1): 3–14.
11.
EstradaVDe Villar NG, Larrad MTet al. Long-term metabolic consequences of switching from protease inhibitors to efavirenz in therapy for human immunodeficiency virus-infected patients with lipoatrophy. Clin Infect Dis2002; 35.
12.
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services,www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf (accessed 17 June 2020).
MallonP, et al. Weight gain before and after switch from TDF to TAF. In: 23rd International AIDS conference, 6–10 July 2020 (abstract 3283).
15.
KuoPHSunHYChuangYC, et al. Weight gain and dyslipidemia among virally suppressed HIV-positive patients switching to co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide. Int J Infect Dis2020; 92: 71–77.
16.
MenardAMeddebLTissot-DupontH, et al. Dolutegravir and weight gain: an unexpected bothering side effect?AIDS2017; 31: 1499–1500.
17.
HillAWatersLPozniakA.Are new antiretroviral treatments increasing the risks of clinical obesity?J Virus Erad2019; 5(1): 41–43.
18.
GorwoodJBourgeoisCPourcherV, et al. The integrase inhibitors dolutegravir and raltegravir exert pro-adipogenic and profibrotic effects and induce insulin resistance in human/simian adipose tissue and human adipocytes. Clin Infect Dis. Epub ahead of print 13 March 2020. DOI: 10.1093/cid/ciaa259.
19.
BailinAAGabrielCLWanjallaCN, et al. Obesity and weight gain in persons with HIV. Curr HIV/AIDS Rep2020; 17(2): 138–150.
