1398. WEIGHT GAIN AFTER SWITCH FROM EFAVIRENZ-BASED TO INTEGRASE INHIBITOR-BASED REGIMENS
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • IDSA Poster 9.27.2017.pdf (343.3 kB)
  • Background:

    Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) offers persons living with HIV a potent new treatment option. Recently, local HIV clinicians noted weight gain in patients who switched from daily, fixed-dose efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) to fixed-dose dolutegravir/abacavir/lamivudine (DTG/ABC/3TC). To assess whether regimen switch was significantly associated with weight gain, we evaluated body weight over time among patients with sustained virologic suppression who switched from EFV/TDF/FTC to an INSTI-containing regimen, including DTG/ABC/3TC.

    Methods:

    We analyzed data from adult patients on EFV/TDF/FTC for >=2 years with consistent plasma HIV-1 RNA <1000 copies/mL prior to date of switch (or date of sham switch for those who remained on EFV/TDF/FTC). All maintained HIV-1 RNA <1000 copies/mL for >=18 months post-switch. We assessed weight change over 18 months in patients switched to an INSTI-containing regimen or a protease inhibitor (PI)-containing regimen versus those remaining on EFV/TDF/FTC over the same period. In a sub-group analysis, we compared patients switched to DTG/ABC/3TC versus raltegravir- or elvitegravir-containing regimens. Linear mixed effects models assessed mean differences in weight over time, adjusting for baseline age, sex, race, CD4+ count and weight.

    Results:

    Among 495 patients, 136 switched to an INSTI-containing regimen, 34 switched to a PI-containing regimen, and 325 remained on EFV/TDF/FTC. Patients switched to an INSTI-containing regimen gained an average of 2.9 kilograms (kg) at 18 months compared to 0.9 kg among those continued on EFV/TDF/FTC (p=0.003, Figure a), while those switched to a PI regimen gained 0.7 kg (p=0.81, Figure b). Among INSTI regimens, those switched to DTG/ABC/3TC gained 5.3 kg at 18 months, which was more than raltegravir or elvitegravir regimens (p=0.19, Figure c) and significantly more than those continued on EFV/TDF/FTC (p=0.001, Figure d).

    Conclusion:

    Switching from daily, fixed-dose EFV/TDF/FTC to an INSTI-containing regimen among patients with virologic control was associated with weight gain at 18 months. This weight gain was particularly profound among those switching to DTG/ABC/3TC.

    Jamison Norwood, MD1, Megan Turner, M.A.2, Carmen Bofill, M.P.H.2, Cathy Jenkins, M.S.3, Sally Bebawy, B.S.2, Peter Rebeiro, Ph.D., M.H.S.4, Todd Hulgan, MD, MPH, FIDSA5, Stephen Raffanti, MD, MPH, FIDSA6, David Haas, MD, FIDSA7, Timothy R. Sterling, MD, FIDSA8 and John Koethe, MD9, (1)Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, (2)Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, (3)Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, (4)Vanderbilt University School of Medicine, Nashville, TN, (5)Medicine, Vanderbilt University Medical Center, Nashville, TN, (6)Vanderbilt University Medical Center, Nashville, TN, (7)Medicine, Vanderbilt University School of Medicine, Nashville, TN, (8)Vanderbilt Tuberculosis Center, Vanderbilt University Medical Center, Nashville, TN, (9)Department of Medicine, Division of Infectious Diseases, Vanderbilt University, Nashville, TN

    Disclosures:

    J. Norwood, None

    M. Turner, None

    C. Bofill, None

    C. Jenkins, None

    S. Bebawy, None

    P. Rebeiro, None

    T. Hulgan, None

    S. Raffanti, None

    D. Haas, None

    T. R. Sterling, None

    J. Koethe, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.