Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended first line for HIV treatment. Studies have suggested individuals who switch to INSTI-ART experience increase in body weight. These changes may be more prominent in women. We evaluated the effect of INSTI use on body weight and measurements in HIV+ women.
Data were collected from 2008-2017 from HIV+ women enrolled in the Women’s Interagency HIV Study (WIHS) with viral load <1000 copies/mL on ART. Women who switched to or added an INSTI to ART (SWAD group) were compared to women who remained on non-INSTI ART (STAY group). Outcomes included changes in body weight; body mass index (BMI); percentage body fat (PBF); circumference of waist, hip, arm, and thigh; blood pressure (BP); and incident diabetes mellitus (DM). Outcomes were measured 6-12 months before and 6-18 months after INSTI switch/add in the SWAD group with comparable time points in the STAY group. Baseline demographic and clinical characteristics for STAY and SWAD groups were compared. Linear regression models compared change over time in each outcome by STAY/SWAD group, adjusted for age, race, WIHS site, education, income, smoking status, and baseline ART regimen. Changes in outcomes were also stratified by INSTI type (dolutegravir or raltegravir/elvitegravir).
1118 WIHS participants (884 STAY and 234 SWAD) were followed for average 2.0 (+/- 0.1) years; mean baseline age was 48.8 (+/- 8.8) years, 61% were Black, and mean CD4 669 (+/- 294) cells/mm3. At baseline, women in SWAD group were more likely to be on protease inhibitor-ART but did not differ from STAY by demographics or body measurements. Compared to the STAY group, the SWAD group experienced 2.14 kg greater increase in weight, 0.78 kg/m² greater increase in BMI, 1.35% greater increase in PBF, and 2.05, 1.87, 0.58, and 0.98 cm greater increases in waist, hip, arm, and thigh circumference, respectively (Table 1). Women in SWAD also had 2.24 and 1.17 mmHg greater change in systolic and diastolic BP. New-onset DM occurred in 4.5% (n=8) in SWAD and 2.2% (n=15) in STAY, p=0.11. No significant differences in outcomes were observed by INSTI type.
In a longitudinal study of HIV+ women on ART, a switch to INSTI was associated with significant increases in body weight and measurements, body fat, and blood pressure compared to those remaining on non-INSTI ART. Further research is urgently needed for prevention and management of metabolic effects with INSTI use.