Background:
We and others have previously reported that excessive weight gain (WG) is common in virally suppressed people with HIV (PWH) after switching to TAF and/or INSTI. Data on reversibility of TAF and/or INSTI-associated WG are currently limited to case reports.
Methods:
From the Dutch ATHENA Cohort, we selected all PWH with ≥7% WG within 24 months after first switch to TAF and/or INSTI whilst being virally suppressed. PWH with comorbidities/co-medication known to be associated with WG were excluded. We subsequently selected those who discontinued only TAF, only INSTI or both TAF+INSTI, with ≥1 weight measurement ≥3 months after discontinuation. Weight change limited to the 24 months both prior and after discontinuation was modelled using mixed-effects linear regression, adjusted for age, last available weight prior to discontinuation, sex and region of origin. We compared change in weight of these individuals to PWH with ≥7% WG who continued TAF and/or INSTI (those initiating or discontinuing TAF or INSTI were not included) with ≥1 weight measurement ≥3 months after first recording of ≥7% WG.
Results:
WG ≥7% was observed in 23.1% of the 6,245 PWH switching to TAF and/or INSTI in total, of whom 165 subsequently discontinued TAF and/or INSTI. Sufficient follow-up (median 24 months (IQR 18-54)) was available for 69/165 (Table 1). Mean WG on TAF and/or INSTI within 24 months prior to discontinuation was +3.20kg [95%CI, 1.02-5.40] in PWH who subsequently discontinued only TAF (n=21); +5.98kg [3.34-8.37] in the only INSTI (n=37) and +5.84 [2.06-9.30] in the TAF+INSTI group (n=11). At 24 months after discontinuation, weight change was -1.48kg [-4.24 to +1.27]; -2.73kg [-6.22 to +0.66] and -7.95kg [-15.57 to -0.33] in those three groups, respectively. Reductions in proportions overweight/obesity were observed in all three groups, but these were markedly less pronounced than the BMI category shifts having occurred whilst on TAF and/or INSTI (Table 1). In the 800 PWH who continued TAF and/or INSTI after ≥7% WG (245 only TAF; 347 only INSTI; 208 TAF+INSTI), the adjusted mean weight change at 24 months after first recording of ≥7% WG was -0.77kg [-1.32 to -0.21].
Conclusions:
TAF and/or INSTI-associated WG of ≥7% appears to be only partly reversible after discontinuing TAF and/or INSTI, with relatively modest improvement in BMI category. In contrast, in those continuing TAF and/or INSTI after first recording of ≥7% WG, weight remains relatively unchanged.
Characteristics of 69 PWH with ≥7% WG before starting and after stopping either TAF, INSTI or both; versus 800 PWH with ≥7% WG continuing TAF and/or INSTI