Weight gain has been associated with integrase strand transfer inhibitor (INSTI) based regimens in adults, but this has not been studied in children and youth with perinatally acquired HIV. We investigated the change in body mass index (BMI) among young persons living with HIV (YPLWH) initiating INSTI-based regimens for the first time within an observational cohort in Washington DC (DC Cohort).
YPLWH (0-24 years of age) who initiated INSTI-based regimens between Jan 2011 and Mar 2018, and had ≥2 BMIs recorded at least 6 months apart within 2 years pre- and post-INSTI initiation were eligible. We compared the trajectory of BMI (or BMI-for-age z-score for those ≤19 years of age) pre- and post-INSTI initiation using piecewise linear mixed effects models, and adjusted for potential confounders.
We enrolled 51 YPLWH (median age 18 years (IQR 15-21), 47% male, 94% black, 72% perinatally infected, 59% initiated dolutegravir, 57% had a history of AIDS). Pre-INSTI, 59% were on a protease inhibitor based regimen and 4% were ART-naive. At INSTI initiation, median BMI was 21.4 m/kg2 (IQR: 19.6-24.3), CD4 count was 574 cells/mL (IQR: 348-834), 43% had HIV viral load < 200 copies/mL. Fifty one YPLWH had 720 BMI measurements (median BMI measurements per YLPWH 13 (IQR: 11-17)) with a mean BMI change of +0.37 (p=0.04) and +0.98 kg/m2/year (p<0.0001), in the two years pre- and post-INSTI initiation respectively. There was a greater rate of BMI change post- vs. pre-INSTI of +0.6 kg/m2/year (p=0.05, Fig. 1a). Sub-cohort of YPLWH (≤19 years of age (n=27)) had 312 BMI-for-age z-score measurements (median z-score measurements per YLPWH 12 (IQR: 10-15)) with a mean z-score change of -0.04 (p=0.51) and +0.21 units/year (p=0.01), pre- and post-INSTI initiation respectively. YPLHIV ≤19 years had a significantly greater rate of BMI-for-age z-score change of +0.25 units/year (p=0.03, Fig. 1b) when comparing trajectories post- vs. pre-INSTI after adjusting for age at INSTI initiation, sex, race, mode of HIV acquisition and most recent CD4 count and VL (β=0.22, p=0.05).
Similar to adults, we report a greater rate of BMI and BMI-for-age z-score change following switch to INSTI in predominantly perinatally infected YPLWH. Although the final BMI remained in the normal range, our findings support the need for continued monitoring of BMI trends and potential cardiometabolic implications in YPLWH receiving INSTIs to assess if this represents more than a return to health phenomenon.