Weight Gain On Integrase Inhibitor-based Antiretroviral Therapy
Weight Gain on Integrase Inhibitor-basedAntiretroviral TherapyJohn Koethe, MD, MSCIAssociate Professor of MedicineDivision of Infectious DiseasesPEPFAR Scientific Advisory BoardOctober 16, 2019UNCLASSIFIED
2017: Early Reports of Weight Gain in PWH Switched toDolutegravir-based Regimensn 495 Adults on Efavirenz (EFV) and Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC) with 2 yearsof viral suppression switched to an Integrase Inhibitor (INSTI)-based regimen Weight gain highest among those switching to Doultegravir (DTG) with Abacavir/Lamivudine(ABC/3TC)Norwood J. et al. JAIDS, 2017UNCLASSIFIED
Weight Gain in Treatment-Naïve Persons Starting ART inNorth America22,972 patients starting ART from 2007-2016 in the US and CanadaRebeiro P, IDweek 2019UNCLASSIFIED
Mean Weight Changefrom Baseline (kg)Integrase Inhibitors and Weight Gain in Pooled cobiWeeks of TreatmentSax, P. et al. CID 2019. in pressUNCLASSIFIED
Adjusted Odds of a 10% Weight Gain at 2- and 5-yearsamong PWH in North AmericaAdjusted odds of a 10% weight gainBourgi, K. et al. et al. submittedUNCLASSIFIED
NAMSAL Study – ART naïve PWH starting Dolutegravirvs. Efavirenz with TDF/FTC in CameroonDTG TDF/3TC(n 293)EFV TDF/3TC(n 278)p-value fordifferenceWeight (kg) 5 3 0.001BMI (kg/m2) 1.7 1.2 0.001Treatment-emergent overweight(BMI 25 – 29.9), n (%)16%17%n.s.Treatment-emergent obesity(BMI 30), n (%)12%5% 0.01Week 48Mean change from baseline:IAS, Mexico City, 2019UNCLASSIFIED
NAMSAL Study: Treatment Emergent Obesity at 48weeks2018161412108642014%12%7%2%TDF/3TC DTG TDF/3TC/EFV TDF/3TC DTG TDF/3TC/EFVMenIAS, Mexico City, 2019WomenUNCLASSIFIED
ADVANCE Study: ART naïve PWH starting Dolutegravir TAF vs. TDF or Efavirenz TDF in South AfricaChange in weight over 96 weeks by regimen:MenIAS, Mexico City, 2019WomenUNCLASSIFIED
Mean Weight Changefrom Baseline (kg)NRTIs and Weight Gain in Pooled Clinical TrialsTAFABCTDFAZTWeeks of TreatmentSax, P. et al. CID 2019. in pressUNCLASSIFIED
Does Weight Gain Matter? Incident diabetesmellitus after ARTinitiation in NorthAmerica Cox regression adjustedfor age, sex, race, HIVtransmission risk, yearof ART initiation, andbaseline weight, CD4 count, and HIV-1 RNA Differences partiallyabrogated whenadjusted for 12-monthweight changeARTARTIncidentRiskIncidentDiabetesDM0.00By Class1.22INSTIs1.25PIsNNRTIs (Ref.) 0.00By Drug1.50RAL1.14DTG0.96EVG1.22PIsNNRTIs (Ref.) 0.00N 21,516Rebeiro P, IDweek 2019UNCLASSIFIED0.50 0.75 1.00 1.25 1.50 1.75 2.00aHR for Incident DM
Summary: Integrase Inhibitors and Weight Gain In a large North American observational cohort study andseveral clincial trials, PWH starting integrase inhibitor-basedregimens, particularly dolutegravir, had greater weight gain Women and non-whites seem to be at highest risk of weightgain with integrase inhibitors Clincial trials show an independent effect of TAF on weight,which was greatest for women in ADVANCE (South Africa) A preliminary North American study showed a higher risk ofincidence diabetes with integrase inhibitors; more data areneeded from other regionsUNCLASSIFIED
Supplementary SlidesUNCLASSIFIED
Weight Gain in Treatment-Naïve Persons Starting ART inNorth AmericaUNCLASSIFIED
Weight Gain in Treatment-Naïve Persons Starting ART inNorth AmericaUNCLASSIFIED
ADVANCE Study: Change in Body Compostion Over Timeby Regimen:MenWomenIAS, Mexico City, 2019UNCLASSIFIED
UNCLASSIFIED Norwood J. et al. JAIDS, 2017 Adults on Efavirenz (EFV) and Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC) with 2 years of viral suppression switched to an Integrase Inhibitor (INSTI)-based regimen Weight gain highest among those switching to Doultegravir (DTG) with Abacavir/Lamivudine (ABC/3TC) 2017: Early Reports of Weight Gain in PWH Switched to
HIV-1 Integrase becomes a potential target for anti-HIV therapy. L-Chicoric acid has been found to be one of the most potent HIV-1 integrase inhibitor. Chicoric acid and its analogues act against HIV . lemon balm, and aquatic plants, including algae and sea grasses.
The inhibition efficiency of inhibitor was determined by using equation 2. IE (1- K / K. o) 100 (2) where K is the corrosion rate with inhibitor and K. o. is the corrosion rate without inhibitor. The surface coverage area of inhibitor was measured by equation 3. θ (1 - K / K. o) (3)
INSTI: Significant weight gain. Greater magnitude of weight gain in people of African descent and women: Probably greater with DTG and BIC than RAL.4,5,6 NRTIs: Greater weight gain with TAF vs. ABC and TDF;5,6 and greater weight gain with INSTI in conjunction with TAF.1 NNRTI less conducive to weight gain.5,6,7,8
Stat 152 - Weight Gain December 15, 2006 Figure 6: Weight gain vs. courses taken tween workload and weight gain. While it can be ar-gued that students under high stress eat less healthy meals, and may gain weight as a result, they also more likely to eat irregularly. Figures 5 and 6 which shows how weight gain is related to unit load and
marked weight gain group the mean weight gain was 11.4 kg 4.9 kg (range 5.5-30.1 kg). The mean overall weight change in the 70 patients was 6.9 kg 5.8 kg (range —4.0-30.1 kg). The highest maximum weight gain observed was 54% of initial body weight for VPA. This corresponded to a 30 kg weight gain over a period of 15 months.
Test group: Weight gain goals and Super Weight Gain RPG The pre-test would involve measuring the weight and BMI of each individual, along with an open-response test on the topic of weight-gain in order gauge how much the player currently knows about healthy weight-gain
A weight gain of 2 pounds per month is recommended during the 2nd and 3rd trimester. 3. Find the Right Weight Gain Grid The weight gain grid is a tool that helps you see if the woman is gaining within the recommended range. Choose the grid that matches her weight category. There are four weight gain grids for women with a
with API 650’s level of risk of tank failure. Likewise, the rules in the external pressure appendix will be consistent with the basic part of API 650 with regard to loading conditions and combinations. Thus, starting with a specified design external pressure, roof live or snow load, and wind pressure (or velocity), the total roof design pressure is calculated as the greater of DL (Lr or S .
