Impact of switching to bictegravir- or dolutegravir-based antiretroviral therapy on weight in people living with HIV during the COVID-19 pandemic.

Abstract

Objective: This study aims to evaluate weight change in people living with HIV (PLWH) who switched to dolutegravir (DTG)- or bictegravir (BIC)-based antiretroviral regimens compared to those who remained on regimens that did not contain integrase strand transfer inhibitors (INSTIs) during the COVID-19 pandemic.

Methods: This retrospective cohort study included virologically-suppressed PLWH seen at an HIV clinic between 1 January 2020 to 31 December 2023. Patients aged 18 years and older were included if they switched from raltegravir- or elvitegravir-based to DTG- or BIC-based regimens (Group 1), from non-INSTI-based to DTG- or BIC-based regimens (Group 2), or remained on non-INSTI-based regimens (Group 3). Pregnant PLWH were excluded. The primary outcome was absolute weight change from index visit date to 6 and 12 months.

Results: A total of 200 patients were included (n = 45 in Group 1, n = 26 in Group 2, and n = 129 in Group 3). Groups 1 and 2 experienced a median weight increase of 0.9 kg and 0.5 kg, respectively, from index to 12 months, while Group 3 experienced a median weight decrease of 1.1 kg from index to 12 months. Body mass index (BMI) increased from index to 12 months by a median of 0.5 kg/m² and 0.4 kg/m² in Groups 1 and 2, respectively, and decreased by a median of 0.4 kg/m² in Group 3. Hemoglobin A1c increased by a median of 0.1% in Groups 1 and 2 with no change in Group 3. Using mixed linear models adjusted for sex, age, and baseline BMI, there were no significant changes in adjusted mean weight, A1c, and LDL across the groups from index to 6 and 12 months. In Group 3, patients at the upper quartile of age were observed to experience a significant BMI decrease from index to 12 months (p = 0.008).

Conclusion: Switching to BIC- or DTG-based regimens during the COVID-19 pandemic was not associated with weight gain in treatment-experienced, virologically-suppressed PLWH in this single-center study. The study findings may reassure clinicians who are hesitant about switching treatment-experienced patients to newer BIC- or DTG-containing regimens due to concerns about potential weight gain.