Nikos Pantazis, Caroline A Sabin, Sophie Grabar, Marc Van der Valk, Inma Jarrin, Ard van Sighem, Laurence Meyer, Christina Carlander, John Gill, Alain Volny Anne, Bruno Spire, Shema Tariq, Fiona Burns, Dominique Costagliola, Elisa Ruiz-Burga, Giota Touloumi, Kholoud Porter
{"title":"在接近 HIV-1 血清转换期开始抗逆转录病毒治疗后体重的变化：一项国际队列协作。","authors":"Nikos Pantazis, Caroline A Sabin, Sophie Grabar, Marc Van der Valk, Inma Jarrin, Ard van Sighem, Laurence Meyer, Christina Carlander, John Gill, Alain Volny Anne, Bruno Spire, Shema Tariq, Fiona Burns, Dominique Costagliola, Elisa Ruiz-Burga, Giota Touloumi, Kholoud Porter","doi":"10.1016/S2352-3018(24)00183-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Understanding the reasons for and consequences of bodyweight change in people living with HIV initiating antiretroviral therapy (ART) is crucial to optimising long-term health and wellbeing. We aimed to examine bodyweight trends and associated factors among individuals with well estimated dates of HIV-1 seroconversion.</p><p><strong>Methods: </strong>In this cohort study, we pooled retrospective data from clinical records of participants in CASCADE aged 16 years and older recruited from clinics in France, Greece, the Netherlands, Spain, Sweden, the UK, and Canada. All participants had well estimated dates of HIV-1 seroconversion, seroconverted between Jan 1, 2007, and Dec 31, 2022 (HIV-1 positive antibody test within 12 months of an HIV-1 negative antibody test, or other laboratory evidence of seroconversion), initiated ART within 1 year of seroconversion, and were previously ART-naive. Participants were followed up to the time of data pooling (May 31, 2023). We modelled bodyweight changes after ART initiation by ART class, BMI categories, and other demographic characteristics using linear mixed models.</p><p><strong>Findings: </strong>Of 15 755 potentially eligible participants, 5698 met inclusion criteria. Of those, 5148 (90·3%) were assigned male at birth, 517 (9·1%) were assigned female at birth, and 33 (0·6%) had sex not known. 2778 (48·8%) participants initiated integrase strand transfer inhibitor (INSTI)-based ART regimens, 1809 (31·7%) initiated protease inhibitor-based regimens, and 1111 (19·5%) initiated non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. The majority of participants were men who have sex with men (MSM; 4519 [79·3%]). Median age at seroconversion was 33·7 years (IQR 26·9-43·2). Bodyweight changes differed significantly by ART class within all baseline BMI categories (BMI <18·5 kg/m<sup>2</sup> p=0·026, BMI 18·5-24·9 kg/m<sup>2</sup> p<0·0001, BMI 25·0-29·9 kg/m<sup>2</sup> p=0·0021, and BMI ≥30·0 kg/m<sup>2</sup> p=0·0033; ART class and BMI interaction p=0·011). Participants with BMI less than 30 kg/m<sup>2</sup> on regimens including both INSTI and tenofovir alafenamide gained 4·76 kg (95% CI 4·05-5·46) or more at 3 years. Of those with baseline BMI 18·5-24·9 kg/m<sup>2</sup>, 31·3% (95% CI 29·5-33·1) on INSTI-based regimens, 25·3% (23·0-27·7) on protease inhibitor-based regimens, 20·4% (18·8-22·9) on NNRTI-based regimens, 37·4% (33·9-40·9) on tenofovir alafenamide-based regimens, and 38·4% (34·6-42·1) on tenofovir alafenamide and INSTI-based regimens had gained more than 10% of their baseline bodyweight at 3 years. The greatest 3-year bodyweight gains by individuals on INSTI-based regimens and with BMI 18·5-24·9 kg/m<sup>2</sup> were in women (5·63 kg [95% CI 4·92-6·35]), and people originating from sub-Saharan African (5·76 kg [5·06-6·46]), compared with MSM (3·82 kg [3·50-4·13]).</p><p><strong>Interpretation: </strong>Our findings suggest a direct effect of INSTIs and tenofovir alafenamide on bodyweight gain, rather than a return to health effect. Given the known risk for cardiometabolic disease, bodyweight management needs to be part of the overall care of individuals prescribed these drugs.</p><p><strong>Funding: </strong>ViiV Healthcare UK, Janssen Pharmaceutica, and Merck Sharp & Dohme.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e660-e669"},"PeriodicalIF":12.8000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Changes in bodyweight after initiating antiretroviral therapy close to HIV-1 seroconversion: an international cohort collaboration.\",\"authors\":\"Nikos Pantazis, Caroline A Sabin, Sophie Grabar, Marc Van der Valk, Inma Jarrin, Ard van Sighem, Laurence Meyer, Christina Carlander, John Gill, Alain Volny Anne, Bruno Spire, Shema Tariq, Fiona Burns, Dominique Costagliola, Elisa Ruiz-Burga, Giota Touloumi, Kholoud Porter\",\"doi\":\"10.1016/S2352-3018(24)00183-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Understanding the reasons for and consequences of bodyweight change in people living with HIV initiating antiretroviral therapy (ART) is crucial to optimising long-term health and wellbeing. We aimed to examine bodyweight trends and associated factors among individuals with well estimated dates of HIV-1 seroconversion.</p><p><strong>Methods: </strong>In this cohort study, we pooled retrospective data from clinical records of participants in CASCADE aged 16 years and older recruited from clinics in France, Greece, the Netherlands, Spain, Sweden, the UK, and Canada. All participants had well estimated dates of HIV-1 seroconversion, seroconverted between Jan 1, 2007, and Dec 31, 2022 (HIV-1 positive antibody test within 12 months of an HIV-1 negative antibody test, or other laboratory evidence of seroconversion), initiated ART within 1 year of seroconversion, and were previously ART-naive. Participants were followed up to the time of data pooling (May 31, 2023). We modelled bodyweight changes after ART initiation by ART class, BMI categories, and other demographic characteristics using linear mixed models.</p><p><strong>Findings: </strong>Of 15 755 potentially eligible participants, 5698 met inclusion criteria. Of those, 5148 (90·3%) were assigned male at birth, 517 (9·1%) were assigned female at birth, and 33 (0·6%) had sex not known. 2778 (48·8%) participants initiated integrase strand transfer inhibitor (INSTI)-based ART regimens, 1809 (31·7%) initiated protease inhibitor-based regimens, and 1111 (19·5%) initiated non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. The majority of participants were men who have sex with men (MSM; 4519 [79·3%]). Median age at seroconversion was 33·7 years (IQR 26·9-43·2). Bodyweight changes differed significantly by ART class within all baseline BMI categories (BMI <18·5 kg/m<sup>2</sup> p=0·026, BMI 18·5-24·9 kg/m<sup>2</sup> p<0·0001, BMI 25·0-29·9 kg/m<sup>2</sup> p=0·0021, and BMI ≥30·0 kg/m<sup>2</sup> p=0·0033; ART class and BMI interaction p=0·011). Participants with BMI less than 30 kg/m<sup>2</sup> on regimens including both INSTI and tenofovir alafenamide gained 4·76 kg (95% CI 4·05-5·46) or more at 3 years. Of those with baseline BMI 18·5-24·9 kg/m<sup>2</sup>, 31·3% (95% CI 29·5-33·1) on INSTI-based regimens, 25·3% (23·0-27·7) on protease inhibitor-based regimens, 20·4% (18·8-22·9) on NNRTI-based regimens, 37·4% (33·9-40·9) on tenofovir alafenamide-based regimens, and 38·4% (34·6-42·1) on tenofovir alafenamide and INSTI-based regimens had gained more than 10% of their baseline bodyweight at 3 years. The greatest 3-year bodyweight gains by individuals on INSTI-based regimens and with BMI 18·5-24·9 kg/m<sup>2</sup> were in women (5·63 kg [95% CI 4·92-6·35]), and people originating from sub-Saharan African (5·76 kg [5·06-6·46]), compared with MSM (3·82 kg [3·50-4·13]).</p><p><strong>Interpretation: </strong>Our findings suggest a direct effect of INSTIs and tenofovir alafenamide on bodyweight gain, rather than a return to health effect. Given the known risk for cardiometabolic disease, bodyweight management needs to be part of the overall care of individuals prescribed these drugs.</p><p><strong>Funding: </strong>ViiV Healthcare UK, Janssen Pharmaceutica, and Merck Sharp & Dohme.</p>\",\"PeriodicalId\":48725,\"journal\":{\"name\":\"Lancet Hiv\",\"volume\":\" \",\"pages\":\"e660-e669\"},\"PeriodicalIF\":12.8000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lancet Hiv\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/S2352-3018(24)00183-8\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Hiv","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/S2352-3018(24)00183-8","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：了解开始接受抗逆转录病毒疗法（ART）的 HIV 感染者体重变化的原因和后果对于优化长期健康和福祉至关重要。我们旨在研究HIV-1血清转换日期估计准确的个体的体重趋势和相关因素：在这项队列研究中，我们汇总了从法国、希腊、荷兰、西班牙、瑞典、英国和加拿大诊所招募的 16 岁及以上 CASCADE 参与者临床记录中获得的回顾性数据。所有参与者的HIV-1血清学转换日期均有明确估计，血清学转换时间为2007年1月1日至2022年12月31日（HIV-1抗体检测阴性后12个月内HIV-1抗体检测阳性，或血清学转换的其他实验室证据），血清学转换后1年内开始接受抗逆转录病毒疗法，且之前未接受过抗逆转录病毒疗法。我们对参与者进行了随访，直至数据汇总之时（2023 年 5 月 31 日）。我们使用线性混合模型，按照抗逆转录病毒疗法类别、体重指数类别和其他人口统计学特征对开始抗逆转录病毒疗法后的体重变化进行了建模：在 15 755 名可能符合条件的参与者中，有 5698 人符合纳入标准。其中，5148 人（90-3%）出生时被指定为男性，517 人（9-1%）出生时被指定为女性，33 人（0-6%）性别不明。2778名参与者（48-8%）开始接受以整合酶链转移抑制剂（INSTI）为基础的抗逆转录病毒疗法，1809名参与者（31-7%）开始接受以蛋白酶抑制剂为基础的疗法，1111名参与者（19-5%）开始接受以非核苷类逆转录酶抑制剂（NNRTI）为基础的疗法。大多数参与者是男男性行为者（MSM；4519 [79-3%]）。血清转换时的中位年龄为 33-7 岁（IQR 26-9-43-2）。在所有基线体重指数（BMI）类别中，体重变化因 ART 级别而有显著差异（BMI 2 p=0-026，BMI 18-5-24-9 kg/m2 p2 p=0-0021，BMI ≥30-0 kg/m2 p=0-0033；ART 级别与 BMI 的交互作用 p=0-011）。BMI小于30 kg/m2、同时接受INSTI和替诺福韦阿拉非酰胺治疗方案的参与者在3年内体重增加了4-76 kg (95% CI 4-05-5-46)或更多。在基线体重指数为 18-5-24-9 kg/m2 的患者中，31-3%（95% CI 29-5-33-1）采用 INSTI 方案，25-3%（23-0-27-7）采用蛋白酶抑制剂方案，20-4%（18-8-22-9）采用 NNRTI 方案、37-4%（33-9-40-9）服用替诺福韦阿拉非酰胺类药物的患者，38-4%（34-6-42-1）服用替诺福韦阿拉非酰胺类药物和 INSTI 类药物的患者，3 年后体重增加超过基线的 10%。与 MSM（3-82 kg [3-50-4-13]）相比，使用 INSTI 治疗方案且体重指数为 18-5-24-9 kg/m2 的女性（5-63 kg [95% CI 4-92-6-35]）和撒哈拉以南非洲裔人群（5-76 kg [5-06-6-46]）的 3 年体重增加幅度最大：我们的研究结果表明，INSTIs 和替诺福韦-阿拉非那胺对体重增加有直接影响，而不是恢复健康的影响。鉴于已知的心血管代谢疾病风险，体重管理需要成为处方这类药物的个人整体护理的一部分：资金来源：ViiV Healthcare UK、Janssen Pharmaceutica 和 Merck Sharp & Dohme。
Changes in bodyweight after initiating antiretroviral therapy close to HIV-1 seroconversion: an international cohort collaboration.
Background: Understanding the reasons for and consequences of bodyweight change in people living with HIV initiating antiretroviral therapy (ART) is crucial to optimising long-term health and wellbeing. We aimed to examine bodyweight trends and associated factors among individuals with well estimated dates of HIV-1 seroconversion.
Methods: In this cohort study, we pooled retrospective data from clinical records of participants in CASCADE aged 16 years and older recruited from clinics in France, Greece, the Netherlands, Spain, Sweden, the UK, and Canada. All participants had well estimated dates of HIV-1 seroconversion, seroconverted between Jan 1, 2007, and Dec 31, 2022 (HIV-1 positive antibody test within 12 months of an HIV-1 negative antibody test, or other laboratory evidence of seroconversion), initiated ART within 1 year of seroconversion, and were previously ART-naive. Participants were followed up to the time of data pooling (May 31, 2023). We modelled bodyweight changes after ART initiation by ART class, BMI categories, and other demographic characteristics using linear mixed models.
Findings: Of 15 755 potentially eligible participants, 5698 met inclusion criteria. Of those, 5148 (90·3%) were assigned male at birth, 517 (9·1%) were assigned female at birth, and 33 (0·6%) had sex not known. 2778 (48·8%) participants initiated integrase strand transfer inhibitor (INSTI)-based ART regimens, 1809 (31·7%) initiated protease inhibitor-based regimens, and 1111 (19·5%) initiated non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. The majority of participants were men who have sex with men (MSM; 4519 [79·3%]). Median age at seroconversion was 33·7 years (IQR 26·9-43·2). Bodyweight changes differed significantly by ART class within all baseline BMI categories (BMI <18·5 kg/m2 p=0·026, BMI 18·5-24·9 kg/m2 p<0·0001, BMI 25·0-29·9 kg/m2 p=0·0021, and BMI ≥30·0 kg/m2 p=0·0033; ART class and BMI interaction p=0·011). Participants with BMI less than 30 kg/m2 on regimens including both INSTI and tenofovir alafenamide gained 4·76 kg (95% CI 4·05-5·46) or more at 3 years. Of those with baseline BMI 18·5-24·9 kg/m2, 31·3% (95% CI 29·5-33·1) on INSTI-based regimens, 25·3% (23·0-27·7) on protease inhibitor-based regimens, 20·4% (18·8-22·9) on NNRTI-based regimens, 37·4% (33·9-40·9) on tenofovir alafenamide-based regimens, and 38·4% (34·6-42·1) on tenofovir alafenamide and INSTI-based regimens had gained more than 10% of their baseline bodyweight at 3 years. The greatest 3-year bodyweight gains by individuals on INSTI-based regimens and with BMI 18·5-24·9 kg/m2 were in women (5·63 kg [95% CI 4·92-6·35]), and people originating from sub-Saharan African (5·76 kg [5·06-6·46]), compared with MSM (3·82 kg [3·50-4·13]).
Interpretation: Our findings suggest a direct effect of INSTIs and tenofovir alafenamide on bodyweight gain, rather than a return to health effect. Given the known risk for cardiometabolic disease, bodyweight management needs to be part of the overall care of individuals prescribed these drugs.
期刊介绍：
The Lancet HIV is an internationally trusted source of clinical, public health, and global health knowledge with an Impact Factor of 16.1. It is dedicated to publishing original research, evidence-based reviews, and insightful features that advocate for change in or illuminates HIV clinical practice. The journal aims to provide a holistic view of the pandemic, covering clinical, epidemiological, and operational disciplines. It publishes content on innovative treatments and the biological research behind them, novel methods of service delivery, and new approaches to confronting HIV/AIDS worldwide. The Lancet HIV publishes various types of content including articles, reviews, comments, correspondences, and viewpoints. It also publishes series that aim to shape and drive positive change in clinical practice and health policy in areas of need in HIV. The journal is indexed by several abstracting and indexing services, including Crossref, Embase, Essential Science Indicators, MEDLINE, PubMed, SCIE and Scopus.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
