CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

811

Dolutegravir, Body Mass Index, and Metabolic Syndrome in the IeDEA Sentinel Research Network Samir K Gupta 1 , Susan Ofner 1 , Beverly Musick 1 , Constantin Yiannoutsos 1 , Gilles Wandeler 2 , Belinda Chihota 3 , Albert Minga 4 , Ephram Mensah 5 , Vidya Mave 6 , Awachana Jiamsukul 7 , Brenda E. Crabtree-Ramírez 8 , Rodrigo C. Moreira 9 , Suzanne Goodrich 1 , Aggrey Semeere 10 , for the Sentinel Research Network of IedEA 1 Indiana University, Indianapolis, IN, USA, 2 University of Bern, Bern, Switzerland, 3 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 4 Centre Médical de Suivi des Donneurs de Sang, Abidjan, Côte d’Ivoire, 5 Espoir Vie - Togo, Lomé, Togo, 6 Byramjee Jeejeebhoy Government Medical College, Pune, India, 7 University of New South Wales, Darlinghurst, Australia, 8 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 9 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 10 Makerere University College of Health Sciences, Kampala, Uganda Background: Dolutegravir (DTG) use has been associated with increased weight compared to efavirenz in many international settings. As such, we hypothesized that DTG is also associated with greater cardiometabolic risk globally. Methods: We performed a cross-sectional study examining associations between DTG use, body mass index (BMI), and metabolic syndrome (MetS; as defined by the International Diabetes Federation) using baseline data of the IeDEA Sentinel Research Network (SRN) cohort study. The SRN prospectively collected data from people with HIV from low-and middle-income sites worldwide, aged ≥40 years, and on ART for at least six months at time of enrollment. Using multivariable linear and logistic regression models, respectively, BMI and MetS were assessed using independent variables of DTG use vs. non-use at enrollment, age, sex, country, smoking status (ever vs. never), and HIV RNA level (<200 vs. ≥200 c/mL). CD4 cell count was not included as it was unavailable in some countries. We assessed the potential for interaction by sex by country. Results: 1446 participants from Brazil (N=212), Côte d'Ivoire (N=298), India (N=188), Kenya (N=77), Mexico (N=193), Togo (N=244), Uganda (N=100), and Zambia (N=134) were included. Overall, 54% were female, 94% had HIV-1 RNA <200c/mL, 53% were using DTG (78% for >6 mos), and median age was 50.5 years. Median BMI was 25.3 kg/m 2 , and 35% had MetS. DTG use and younger age were significantly associated with higher BMI (Table), with a significant interaction by sex by country. In India, females and males had similar BMI; in other countries BMI was similar among females and varied in males (higher in Brazil and Mexico and lower in in Kenya, Uganda, and Zambia). MetS was significantly associated with older age and again with significant interaction by sex by country. Compared to males, females had higher odds [adjusted OR (95% CI)] of MetS in Zambia [20.75 (2.71, 158.97)], Uganda [15.17 (4.69, 49.11)], Kenya [12.53 (2.55, 61.69)], Togo [4.31 (1.98, 9.36)], Côte d'Ivoire [3.21 (1.80, 5.74)], and Mexico [3.02 (1.18, 7.72)], but not in Brazil or India. No other interactions involving DTG use, sex, and country were associated with BMI or MetS. Conclusion: DTG was associated with modestly higher BMI but not with MetS in the IeDEA SRN cohort. These data suggest cardiometabolic risk varies across low- and middle-income settings and is dependent on age, sex, and country. TDF and Efavirenz but Not InSTI or TAF Use Are Associated With Weight Gain During cART Henning J Drechsler 1 , Amneris Luque 1 , Ikwo Oboho 1 , John Hanna 1 , Christopher Clark 2 , Ngozi Enwerem 1 , Roger Bedimo 1 1 University of Texas Southwestern, Dallas, TX, USA, 2 Parkland Health and Hospital Systems, Dallas, TX, USA Background: Combination antiretroviral therapy (cART) containing integrase strand transfer inhibitors (INSTIs) and/or tenofovir alafenamide (TAF) has been associated with greater weight gain (WG) than cART without these drugs. Yet few studies have adjusted for multiple individual antiretrovirals (ARV) and for both anchor and backbone ARV component. Methods: We studied WG in cART-naïve patients by analyzing body mass index (BMI) change every 3 months for 3 years after cART initiation in a large HIV Clinic in the Southern US. From 2008-2022 we studied all patients who initiated cART with either dolutegravir (DTG), bictegravir, elvitegravir, raltegravir, atazanavir, darunavir (DRV), rilpivirine (RIL), or efavirenz (EFV) as exclusive anchor drug

810

Dolutegravir-Based Therapy, Diet, Activity & Weight Gain: 48-Week Prospective Cohort in South Africa Nomathemba Chandiwana 1 , Dessie Tien 2 , Gugulethu Shazi 3 , Geoffrey Chen 2 , Smart Mabweazara 3 , Mahomed-Yunus S. Moosa 4 , Ravindra K. Gupta 5 , Deenan Pillay 6 , Vincent Marconi 7 , Bethany Hedt-Gauthier 8 , Francois Venter 1 , Mark J. Siedner 2 , Suzanne McCluskey 2 , Jennifer Manne-Goehler 2 1 University of the Witwatersrand, Johannesburg, South Africa, 2 Massachusetts General Hospital, Boston, MA, USA, 3 Africa Health Research Institute, Mtubatuba, South Africa, 4 University of KwaZulu Natal, Durban, South Africa, 5 Cambridge University, Cambridge, United Kingdom, 6 University College London, London, United Kingdom, 7 Emory University, Atlanta, GA, USA, 8 Harvard Medical School, Boston, MA, USA Background: Weight gain has been reported among people with HIV (PWH) after transitioning to tenofovir, lamivudine, and dolutegravir (TLD) antiretroviral therapy (ART). However, the contribution of changes in diet and physical activity to weight gain in this population remains poorly understood. We estimated relationships between diet, physical activity, and clinically significant weight gain over 48 weeks among PWH in South Africa after transitioning to TLD. Methods: The DISCO cohort study followed 500 PWH at four public-sector clinics in KwaZulu-Natal, South Africa. Eligible participants were >18 years of age and on efavirenz-based, first-line ART for >6 months before transitioning to TLD by clinic staff. Anthropomorphic, diet, and physical activity data were measured at enrollment, 24-week, and 48-week study visits. Our primary exposures of interest were change in four dietary and exercise behaviors over 48 weeks: (1) fruit consumption, (2) fast-food consumption, (3) sugar-sweetened beverage (SSB) consumption, and (4) physical activity (in metabolic equivalent minutes/week). Our primary outcome was clinically significant weight gain, defined as ≥10% increase in weight from baseline to 48 weeks. We estimated differences in each exposure by presence versus absence of weight gain using multivariable logistic regression models adjusted for age, sex, education, and ART duration. Results: We analyzed data from 367 PWH having a mean age of 43 (standard deviation = 12) years and 78% women. People with clinically significant weight gain had an increase in fruit intake while those without clinically significant weight gain had decreased intake (0.21 servings/week [95% CI: -0.9 to 1.3] v. -1.07 servings/week [95% CI: -1.5 to -0.7], respectively) (p=0.015), but there were no significant differences in frequency of fast-food intake, frequency of SSB consumption or physical activity (Figure 1). In adjusted models, change in fruit intake remained significantly associated with clinically significant weight gain over 48 weeks ([95% CI: 1.0 to 1.1], p=0.033). Conclusion: Clinically significant weight gain was associated with increased fruit intake but not with other dietary or physical activity changes over 48 weeks after transitioning ART. Interventions to modify behavior in this population may have a limited role in mitigating clinical obesity. Pharmacological interventions to mitigate clinical obesity in this population may be needed.

Poster Abstracts

812

CROI 2024 246