Background:
Integrase strand transfer inhibitors (INSTIs) have been associated with greater weight gain in women with HIV (WWH) than men with HIV. The transition to menopause is also associated with body composition changes. Whether INSTI initiation during the menopausal transition affects waist circumference (WC) and BMI trajectories is unknown.
Methods:
From 2006-2019, 1159 non-pregnant virally-suppressed WWH [(424 who switched to an INSTI (INSTI+); 735 who did not switch (INSTI–) during a similar time window] and 904 women without HIV (WWOH) from the Women’s Interagency HIV Study were included. The visit at which WWH reported switching to an INSTI was defined as the index visit. Mixed effect models including quadratic terms were used to evaluate change in WC and BMI by menopausal phase defined using anti-Müllerian hormone, a biomarker of ovarian reserve, at the index. Models were adjusted for demographics, baseline WC or BMI, behavioral factors, comorbidities, and HIV-related factors.
Results:
Overall, 66% identified as Black and 28% were premenopausal, 10% early peri-, 28% late peri-, and 34% postmenopausal at the index. INSTI+ were older than INSTI- and WWOH (median 52 vs 49 vs 47 years) with median BMI 30 vs 29 vs 31.5kg/m2, respectively. 64% of INSTI+ and 79% of INSTI- were on tenofovir DF prior to the index visit. Figure shows the WC trajectory for INSTI+, INSTI-, and WWOH who were premenopausal and late perimenopausal at index visit. In premenopausal women, INSTI+ and INSTI- was associated with a 0.06cm per 6 month (mo) (95%CI:-0.27,0.38) and 0.08cm per 6mo (95%CI:-0.11,0.28) faster linear increase in WC respectively, compared to WWOH; INSTI+ had a 0.05cm per 6mo (95%CI:-0.31,0.40) faster increase than INSTI-. In late perimenopausal women, when compared to WWOH, INSTI+ was associated with significantly faster increases in WC which peaked at 41mo and then declined, while INSTI- had smaller increases in WC (0.14cm per 6mo;95%CI:-0.55,0.33); INSTI+ had a 0.39cm per 6mo (95%CI:0.15,0.63) faster linear increase in WC than INSTI-. In postmenopausal women, INSTI+ was associated with faster WC increases up to 39mo then declines compared to INSTI-. BMI trajectories were similar for late peri- and postmenopausal women.
Conclusions:
Switching to an INSTI-based regimen during late peri- and postmenopause is associated with early accelerated increases in WC and BMI when compared to women who did not switch. Our findings suggest that menopausal status should be considered when switching to an INSTI.
