Commentary on Lahiri et al. Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV.

Abstract

Among women living with HIV (WLWH), increases in body weight and body mass index (BMI, kg/m2) have been observed after switching to the antiretroviral therapies (ART) Integrase Inhibitors (INSTI) and/or Tenofovir Alafenamide (TAF) [1,2]. This has broad implications for the HIV aging process and occurrence of later-life disease. While life expectancy for people living with HIV has increased, primarily due to highly-effective ART, the course of aging with chronic HIV remains relatively unknown. Particularly of interest are long-term ART consequences on individual physiological processes and end-organ systems. Increasing BMI leads to overweight and obesity, primarily due to excess adipose tissue accumulation. This is a sincere consequence of certain ART, mostly observed with use of the newer INSTI, specifically dolutegravir, compared to other INSTI [3–6]. While mechanisms whereby INSTI cause weight gain are not well understood, HIV infection has adverse metabolic and aging-related complications that are further complicated by the overweight and obesity-related side effects of ART in societies where obesity is a chronic disease [7], and overweight and obesity are pandemic [8]. Overweight and obesity have major medical, social, and economic repercussions [8]. Consequently, we can expect more ART-related cardiovascular and cerebrovascular sequelae, as well as polypharmacy to control both HIV infection and vascular risk. The paper by Lahiri, et al. [1] offers insights into the role of ART, specifically INSTI and TAF, on simple clinical measures of body weight and BMI.