Assessing weight change in adolescents and young adults with perinatally acquired HIV and integrase inhibitor use

Integrase strand transfer inhibitors (INSTIs) are the mainstay of treatment in adults and children living with HIV. Weight gain has been associated with INSTI use in adults; however, less data exist on its effects on younger patients. This study aimed to characterize the impact of INSTIs on weight in patients living with perinatally acquired HIV (PAHIV).

Retrospective cohort study of patients with PAHIV maintained on an INSTI for ≥6 months. Descriptive statistics were used to illustrate baseline characteristics. A linear mixed model with spline at the time of INSTI initiation was used to evaluate the primary outcome of the change in body mass index (BMI) slope pre- and post-INSTI use.

Ninety-three patients with PAHIV who initiated INSTIs between June 2010 and September 2021 were included. The median age of INSTI initiation was 19.3 (±5.9) years. Before INSTI initiation, BMI showed a positive trend of 0.11 kg/m² per 6 months (p = 0.2); after INSTI initiation, it increased by 0.26 kg/m² per 6 months (p = 0.002). Although similar post-INSTI BMI increases were seen regardless of age at initiation, a significant BMI change was seen post-INSTI initiation in females, those on concomitant tenofovir alafenamide or other medications that cause weight gain, with baseline BMIs of underweight or healthy weight, bictegravir or dolutegravir exposure and those virologically suppressed at initiation.

In this US cohort of patients with PAHIV initiated on INSTI, a sustained increase in the rate of BMI change was observed. Specific patient variables resulted in a statistically significant increase in weight gain after INSTI initiation.