Weight Changes With Integrase Strand Transfer Inhibitor Therapy in the Management of HIV Infection: A Systematic...

Area of Science:

• HIV/AIDS research
• Pharmacology
• Metabolic health

Background:

• Integrase strand transfer inhibitors (INSTIs) are a preferred first-line treatment for HIV infection.
• Weight changes and associated metabolic concerns are increasingly recognized with antiretroviral therapies.
• Understanding weight dynamics in INSTI therapy is crucial for patient management.

Purpose of the Study:

• To systematically review and describe weight changes associated with integrase strand transfer inhibitor (INSTI) therapy.
• To identify risk factors and specific INSTIs linked to significant weight gain.
• To inform clinical practice regarding weight management in HIV patients on INSTI treatment.

Main Methods:

• Comprehensive literature search of PubMed and CINAHL databases up to December 2021.
• Inclusion of controlled and observational studies reporting weight or BMI changes with INSTI therapy.
• Data extraction focused on comparisons between different INSTIs and other antiretroviral classes.

Main Results:

• Forty-three articles were included, indicating a trend of increased weight with INSTI therapy compared to other antiretrovirals.
• Weight gain appears most pronounced during the initial phase of INSTI treatment.
• Risk factors for weight gain include female gender, lower CD4 count, and co-administration with tenofovir alafenamide; dolutegravir and bictegravir show the highest propensity for weight gain within the INSTI class.

Conclusions:

• INSTI-based regimens are standard for initial HIV management, but potential weight gain requires attention.
• Dolutegravir and bictegravir, especially when combined with tenofovir alafenamide, are associated with the greatest risk of weight gain.
• Further research is necessary to elucidate the mechanisms behind INSTI-associated weight changes and their long-term metabolic and cardiovascular implications.