Low CD4 counts predict excessive weight gains during first-line treatment for HIV

Hill, Andrew, Tovar sanchez, Tamara, Delaporte, Eric, Sokhela, Simiso, Simmons, Bryony ORCID: 0000-0002-3207-9935, Kouanfack, Charles, Mccann, Kaitlyn, Levi, Jacob, Fairhead, Cassandra and Venter, Francois (2024) Low CD4 counts predict excessive weight gains during first-line treatment for HIV. Journal of Antimicrobial Chemotherapy, 79 (9). 2369 - 2378. ISSN 0305-7453

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Abstract

Background: Weight gain is common after antiretroviral initiation, especially among females, those of black race and lower baseline CD4, although this may potentially be due to lower baseline weight. Use of tenofovir disoproxil fumarate or efavirenz can suppress weight gain. Methods: Data were pooled from the ADVANCE (n = 1053), NAMSAL (n= 613) and WHRI001 (n= 536) trials investigating first-line regimen. Week 96 weight and body mass index (BMI) was stratified by baseline CD4. Multivariable models of weight change and incident obesity (BMI ≥30 kg/m 2) were adjusted for baseline CD4, age, sex, tenofovir disoproxil fumarate, efavirenz, baseline BMI and trial. Results: Participants across all treatment arms experienced weight gain from baseline to week 96, with baseline CD4 count, baseline HIV RNA, tenofovir alafenamide and dolutegravir use, and female sex significant predictors. Mean unadjusted weight change was highest with CD4 < 100 (+8.6 kg; SD = 8.2) and lowest with CD4 ≥ 350 (+3.0 kg; SD = 6.5). This weight gain in CD4 < 100 was highest for participants on tenofovir alafenamide-inclusive treatment, such that absolute weight at week 96 was highest in the CD4 < 100 group. Although not statistically significant, obesity rate (BMI ≥ 30 kg/m 2) in those taking TAF/FTC + DTG with CD4 < 100 overtook that seen in CD4 ≥ 350, despite lower baseline obesity prevalence. The unadjusted findings were corroborated in multivariable longitudinal models. Conclusions: Participants with low CD4 may demonstrate significant ‘overshoot’ weight gain, in addition to ‘return to health’, with a trend towards increased risk of obesity when initiated on TAF/FTC + DTG. Use of tenofovir disoproxil fumarate and efavirenz were associated with smaller weight gains. Effective weight management strategies are needed, especially for individuals with low baseline CD4.

Item Type:	Article
Official URL:	https://academic.oup.com/jac
Additional Information:	© 2024 The Author(s)
Divisions:	LSE Health
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RM Therapeutics. Pharmacology
Date Deposited:	01 Aug 2024 13:39
Last Modified:	27 Nov 2024 22:33
URI:	http://eprints.lse.ac.uk/id/eprint/124432

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