Weight gain following antiretroviral therapy (ART) initiation in ART-naive people living with HIV in the current treatment era

Objectives We evaluated weight change among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in the current treatment era. Methods Between 2012-2019, in 8 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites, we identified 3232 ART-naïve PLWH starting 3-drug ART, including efavirenz (EFV), rilpivirine (RPV), atazanavir (ATV), darunavir (DRV), raltegravir (RAL), elvitegravir (EVG), dolutegravir (DTG), or bictegravir (BIC), with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) or abacavir (ABC) and emtricitabine or lamivudine plus a booster if necessary. Weight change was estimated for short-term (6-month) and long-term (all) follow-up using linear mixed models adjusted for time on regimen, interaction between time and regimen, age, sex, race, hepatitis B or C coinfection, nadir CD4, smoking, diabetes, anti-psychotic medication use, and site. Results Mean follow-up was 1.9 years. In the long-term, compared with EFV/TDF, DRV/TDF was associated with a 1.0 kg (95%CI:0.5-1.5) per 6-months greater weight gain, while DTG/ABC was associated with a 0.6 kg (95%CI:0.3-0.9) and DTG/TDF was associated with a 0.6 kg (95%CI:0.1-1.1) per 6- months greater gain. Weight gain on DTG/ABC and DRV/TDF was significantly greater than EFV/TDF, RPV/TDF, and EVG/TDF. In the short-term, compared with EFV/TDF, BIC/TAF (3.9 kg (95%CI:2.2-5.5)) and DTG/TAF (4.4 kg (95%CI:2.1-6.6)) were associated with the greatest weight gain per 6-months, followed by DRV/TDF (3.7 kg (95%CI:2.1-5.2)) and DTG/TDF (2.6 kg (95%CI:1.3-3.9). Conclusions DRV/TDF users showed the greatest weight gain in long-term analyses, that excluded TAF regimens, while DTG/TAF and BIC/TAF users showed the greatest gain in the first 6-months.