HIV, ARVs, And Weight Gain
HIV, ARVs, and Weight GainAustin ChanDivision of Infectious DiseasesMorehouse School of Medicine
Objectives Discuss the history of cART and weight gain Review changes in HIV mortality Review most recent data discussing weight gain withcurrent first line ARV regimens
A Historical Perspective Prior to widespread use of HAART PLWH struggled withwasting and lipoatrophy Often initial weight gain was viewed as “return to health”(reversal of catabolic effects of HIV) Older cART regimens were associated with lipodystrophy(stavudine, zidovudine, indinavir)
Methods Analysis of the National HIV Surveillance System deathdata from 2010 – 2018 ICD-10 data Classified into HIV related, non-HIV related
COAST Cohort Comparative Outcomes and Service Utilization Trends(COAST) Large population-based retrospective cohort studyincluding longitudinal data of HIV-infected adults Population in British Columbia
HIV Causes of Mortality (2016)Eyawo et al COAST Study.2017 17:174 DOI100.1186/st12879-017-2254-7
Non-HIV Infected Causes of MortalityEyawo et al COAST Study.2017 17:174 DOI100.1186/st12879-017-2254-7
HIV and Cardiovascular OutcomesAlonso et al JAHA2019;8:2012241
HIV and Diabetes Mellitus Type IIDuncan et al. Plos ONE13(3):e0194199
Visceral Abdominal Fat and COVID-19 Severity Previous studies have identified obesity as a risk factor forseverity of COVID-19 symptoms, suggesting that body fataccumulation may be linked with greater infection severityand poor clinical outcomes. While these studies focus on BMI, an indirect marker ofbody fat, more recent studies had sought to differentiate thetypes of adipose tissue depots contributing to obesity. In a retrospective analysis assessing abdominal fatdistribution in SARS-CoV-2- positive patients with differentseverity of COVID-19 infection, higher VAT and VAT/TATwere observed in COVID-19 patients that requiredhospitalized patients compared to outpatients (p 0.05)2.1. Petrilli, et al Diabetes Care 2020 2. Chandarana, et al. Abdominal Radiology,2020
Visceral fat associated with increased risk of ICUadmission patients with COVID-19 In a recent study of 144 hospitalized COVID-19 patients, abdominal fatdistribution characterized by increased visceral and lower subcutaneous fatincreased the risk of ICU admission for COVID-19, independent of BMI. VAT thickness and VAT/SAT ratio were associated with increased risk of ICU1admission. ICU-COVID-19 patients had 30% thicker visceral fat than nICU-COVID-19 andnon-COVID-19 patients. Subjects with COVID-19 had thicker VAT than subjects without COVID-19. Excess visceral adipose tissue (VAT) is a metabolically more active tissue thatpromotes hyper inflammation, potentially exacerbating disease severity. The direct role of adipose tissue in disease pathogenesis remains unclear,however additional research is needed to understand whether fat distributioncan predict mortality in patients with COVID-19.1. Battisti, et al. Diabetes Care 2020.
Methods Pooled analysis of 8 Gilead Sciences-sponsored trials ofparticipants initiating ART (2003 – 2015) that satisfied theselection criteria: Phase 3 stageActive-controlled designEnrollment of treatment naïve participantsFollow up duration of 96 weeks
Mean weight change observed at the 48-week time point for theindicated trials, which are organized by date of initiation.
Body mass index category distributions over time in 8 pooledclinical trials
Evidence of Weight Gain in PWH initiating ART8 randomized phase III clinical trials of treatment-naïve PWH initiating ARTStratified by 3rd Agent Class Stratified by INSTIStratified by NRTITAF was associated with greater weight gain at 96 weeks compared to any other NRTI (ABC,ZDV p 0.001, TDF p 0.001). 3. Sax, et al. CID 2020Similar weight gain among PWH initiating INSTIs bictegravir or dolutegravir26
Association between ARVs and weight gainINSTIs and TAF Associated with Greater Weight Gain vs. Other ARVs NRTIs: TAF was associatedwith an increased risk of 10%weight gain compared to ABC,TDF and ZDV 3rd Agent: Compared to EFV,the initiation of BIC or DTG,EVG/c and RPV wasassociated with an increasedrisk of 10% weight gainRisk Factors for Significant ( 10%) Weight Gain in IndividualsInitiating Antiretroviral Therapy3. Sax, et al. CID 202027
DISCOVER – TAF for PREP Phase 3 , blinded trial to look at the safety and efficacy ofPReP with TAF vs TDF Emtricitabine and tenofovir alafenamide wasassociated with weight gain when compared withemtricitabine and tenofovir disoproxil fumarate(mean 1 2 kg difference in bodyweight changebetween groups at week 48)
Conclusions HIV care paradigms have shifted over time Long term side effects of ARVs should be a part ofregimen choice
weight gain compared to ABC, TDF and ZDV 3 rd Agent: Compared to EFV, the initiation of BIC or DTG, EVG/c and RPV was associated with an increased risk of 10% weight gain. Graph: Stepwise model selection was used to identify which baseline risk factors were associated with significant \ 攀 尩 weig\൨t gain in individuals .
Jul 25, 2011 · Multispot HIV-1/HIV-2 2004 Reveal G3 2003 OraQuick Advance 2002 Clearview Complete HIV 1/2 2006 Clearview HIV 1/2 Stat Pack 2006 . Rapid HIV Test Results without Rapid Test Kits . On-board Refrigeration of Multiple Different Assays . . COMPLETE HIV-1/2 (-5) HIV-1/2 STAT-PAK
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.
Epi Profiles Summary: St. Louis HIV Care Region 2017 Epidemiologic Profiles of HIV, STD, and Hepatitis in Missouri 63 Figure 5. HIV disease deaths*, by selected race and year of death, St. Louis HIV Care Region, 2008-2017† *Includes deaths that have occurred among those diagnosed with HIV disease in the St. Louis HIV Care Region.
HIV medication costs approximately 15,000 Euro per year. In Finland, the place of domicile of the HIV positive person pays for the medication. How will HIV affect my life? HIV will not affect your work, studies or hobbies. A person with HIV can date, get married and have children. HIV will not stop you from living a full life.
Drug Interactions in HIV ! ARVs are substrates, inhibitors, and inducers of several metabolic enzymes and transporters ! ARV-ARV interactions very common ! Other concomitant non-HIV medications are also affected ! Increased longevity of HIV-infected patients # shifted need to management of comorbid conditions !
Speaker Biographies Event Organizers István Székely, Principal Advisor, DG ECFIN, European Commission Istvan P. Szekely is currently a Principal Adviser in the European Commission, Directorate General for Economic and Financial Affairs. Previously he was a country director in DG ECFIN. He is
