Characterizing the Impact of Integrase Strand-Transfer Inhibitors on Metabolic in Women Living with HIV Using Two Modeling Approaches Open Access

Angert, Chrisitne (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/gh93h057k?locale=en
Published

Abstract

Background: Integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended first line for HIV treatment. Studies have suggested individuals who switch to INSTI-ART experience increase in body weight. We evaluated the effect of INSTI use on body weight and measurements in women living with HIV (WLHIV) using two separate modeling approaches.

 

Methods: Data were collected from 2008-2017 from WLHIV enrolled in the Women’s Interagency HIV Study (WIHS). Women who switched to or added an INSTI to ART (INSTI group) were compared to women who remained on non-INSTI ART (Control group). Outcomes included changes in body weight; body mass index (BMI); percentage body fat (PBF); circumference of waist, hip, arm, and thigh; blood pressure (BP). Outcomes were measured 6-12 months before and 6-18 months after INSTI switch/add in the INSTI group with comparable time points in the Control group. Linear regression models and mixed-models compared change over time in each outcome by Control/INSTI group, adjusted for age, race, WIHS site, education, income, smoking status, and baseline ART regimen.

 

Results: 1118 WIHS participants (884 Control and 234 INSTI) were followed for average 2.0 years; mean baseline age was 48.8 years, 61% were Black, and mean CD4 669 cells/mm3. Using the cross-sectional approach, the INSTI group experienced 2.14 kg greater increase in weight, 0.78 kg/m² increase in BMI, 1.35% increase in PBF, and 2.05, 1.87, 0.58, and 0.98 cm increases in waist, hip, arm, and thigh circumference, respectively compared to the Control group. In the longitudinal data approach, the INSTI group experienced 1.01 kg greater increase in weight, 0.37 kg/m² increase in BMI, 0.68% increase in PBF, and 1.09, 1.12, 0.31, and 0.54 cm increases in waist, hip, arm, and thigh circumference, respectively compared to the Control group.

 

Conclusion: In a longitudinal study of WLHIV on ART, a switch to INSTI was associated with significant increases in body weight and measurements, body fat, and blood pressure compared to those remaining on non-INSTI ART. Both modeling approached resulted in the same conclusions. Further research is needed for prevention and management of metabolic effects with INSTI use. 

Table of Contents

Introduction. 1

Methods. 3

Study Cohort: The Women’s Interagency HIV Study. 3

Data Acquisition. 4

Inclusion Criteria. 4

Statistical Analysis: Cross-Sectional Approach. 5

Statistical Analysis: Longitudinal Approach. 6

Results. 7

Demographic and Clinical Characteristics. 7

Weight, Body Mass Index, and Percentage Body Fat: Cross Sectional Approach Model. 8

Weight, Body Mass Index, and Percentage Body Fat: Longitudinal Approach Model. 9

Body Circumference & Blood Pressure Measurements: Cross Sectional Approach Model. 9

Body Circumference & Blood Pressure Measurements: Longitudinal Approach Model. 10

Discussion. 11

Conclusion. 12

Tables and Figures. 13

References. 21

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