538. Integrase Inhibitor-Based HAART is Associated with Greater BMI Gains in Blacks, Hispanics and Women
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Changes in BMI following HAART initiation_09-17-18.pdf (763.9 kB)
  • Background: While older protease inhibitors (PI) were more likely to lead to isolated central fat accumulation, progressive increases in generalized obesity in HIV-infected patients following HAART initiation have been observed with most modern regimens, with greater increases in body mass index (BMI) reported in women and with integrase inhibitors (INSTI) use.  We sought to analyze changes in BMI following initiation of HAART in a large urban HIV clinic and identify predictors of BMI changes.

    Methods: All patients initiating HAART at the clinic from 2009 to 2017 were included in the analysis. Exposure to HAART was defined as concurrent receipt of at least two nucleoside reverse transcriptase inhibitors (NRTI) plus at least one PI, Non-nucleoside reverse transcriptase inhibitor (NNRTI) or INSTI.  The effects of sex, race and ethnicity on changes in BMI (kg/m2) per year on HAART were examined using mixed-effects random regression.

    Results: Among the 4048 patients initiating HAART, 69% were male, 53% Black (B), 28% Hispanic (H), and 16% non-Hispanic Whites (NHW).  Mean age was 46.3 years (SD 11.9) and mean BMI was 27.0 (6.4).  

    Median follow-up time on HAART was 6.7 years.  Cumulative exposure to NNRTI, PI, and INSTI-based HAART were 3546, 6184, and 3090 person-years respectively. The BMI slope per year of HAART exposure by regimen type, sex, race and ethnicity are presented in Table 1 and Figure 1. There was no significant interaction between sex and race/ethnicity on BMI. Proportion of overweight/obese (BMI, ≥ 25) increased from 51% at HAART initiation to 65% at year 3 (p<0.001) (Figure 2).

     

     

    All Patients

     

    By Race/Ethnicity

     

    By Sex

     

    N

    Slope

     

    B

    H

    NHW

    P value

     

    Men

    Women

    P value

    All

    4048

    0.26

     

    0.28

    0.26

    0.19

    0.03

     

    0.23

    0.30

    0.008

    NNRTI

    1364

    0.22

     

    0.21

    0.26

    0.12

    0.15

     

    0.24

    0.15

    0.07

    PI

    2087

    0.24

     

    0.27

    0.20

    0.20

    0.23

     

    0.19

    0.33

    0.0004

    INSTI

    2264

    0.32

     

    0.39

    0.32

    0.15

    0.008

     

    0.25

    0.43

    0.005

    Table 1: BMI Slopes by Year on HAART

     

     

    Conclusion: INSTI-based HAART is associated with greater increases in BMI in Blacks and Hispanics. Women had greater BMI gains than men on both PI- and INSTI-based HAART.  The mechanisms of these differential effects by sex and race/ethnicity should be examined in prospective studies.

                           

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    Roger Bedimo, MD, VA North Texas Health Care System, Dallas, TX; Medicine, University of Texas Southwestern Medical Center, Dallas, TX, Beverley Adams-Huet, MS, University of Texas Southwestern Medical Center, Dallas, TX, Barbara S. Taylor, MD, MS, Infectious Diseases, Columbia University, New York, TX, Jordan Lake, MD, MSc, Mcgovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX and Amneris Luque, MD, Infectious Diseases, University of Rochester School of Medicine, Rochester, NY

    Disclosures:

    R. Bedimo, ViiV Healthcare: Consultant and Grant Investigator , Consulting fee and Research grant . Merck & Co.: Consultant and Grant Investigator , Consulting fee and Research grant . Bristol Myers Squibb: Grant Investigator , Research grant . Gilead Sciences: Consultant , Consulting fee .

    B. Adams-Huet, None

    B. S. Taylor, None

    J. Lake, Gilead Sciences: Consultant and Grant Investigator , Consulting fee and Research grant . Merck & Co.: Consultant , Consulting fee .

    A. Luque, None

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