CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

given in Table 1 . Dyslipidemia, hypertension, and pre-frailty/frailty were observed in over 50% of PLWH. The mean (SD) QOL score was 74.2 (±12.2), with the highest scores in physical, spiritual, and social relationships domains. Pre-frailty (β=-4.70, 95% CI:-7.31,-2.07, p<0.01) and frailty (β=-5.52, 95% CI: -9.81,-1.23, p=0.01); ≥1 impaired ADLs (β=-6.34, 95% CI:-9.04,-3.64, p<0.01); mild depression (β=-9.06, 95% CI:-11.90,-6.21, p<0.01) and moderate/severe depression (β=-16.67, 95% CI:-21.39,-11.94, p<0.01) were associated with worse QOL. Conclusions: A high prevalence of geriatric and medical comorbidities in aging PLWH in Tanzania was observed, several of which were associated with lower QOL. These findings highlight the need to implement the screening and prevention of geriatric clinical and psychosocial conditions in PLWH aged ≥50 into routine care.

Conclusions: Switching to a 2-drug antiretroviral therapy by discontinuing abacavir for 48 weeks did not change body weight, fat distribution, or metabolic parameters in PWH.

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Re-Examining InSTI Effects on Weight Gain Among Treatment-Naive People With HIV in North America Kassem Bourgi 1 , Peter F. Rebeiro 2 , Lakeisha Boyd 3 , Samir K. Gupta 4 , Cal Cohen 5 , Jean C. Lee 5 , Jordan E. Lake 6 , Frank Palella 7 , Amy Justice 8 , George Yendewa 9 , Jennifer O. Lam 10 , Michelle Floris-Moore 11 , Marina Klein 12 , Timothy Sterling 2 , John Koethe 2 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Nashville CARES, Nashville, TN, USA, 2 Vanderbilt University Medical Center, Nashville, TN, USA, 3 Indiana University, Bloomington, IN, USA, 4 Indiana University, Indianapolis, IN, USA, 5 Gilead Sciences, Inc, Foster City, CA, USA, 6 University of Texas Health Science Center at Houston, Houston, TX, USA, 7 Northwestern University, Chicago, IL, USA, 8 VA Connecticut Healthcare System, West Haven, CT, USA, 9 Case Western Reserve University, Cleveland, OH, USA, 10 Kaiser Permanente Northern California, Oakland, CA, USA, 11 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 12 McGill University Health Centre, Montreal, Canada Background: Prior analyses highlighted the association between starting INSTI-based antiretroviral therapy (ART) and weight gain among treatment naïve people with HIV (PWH) in the North American AIDS Cohort Collaboration on Research & Design (NA-ACCORD). However, it is unclear whether observed relative weight gain after INSTI initiation reflected weight-suppressive effects of older NNRTIs or confounding due to differences in NRTI backbones. Methods: Adult (≥18 years old), treatment-naïve PWH in NA-ACCORD initiating INSTI, PI, or NNRTI-based ART with dual-NRTI backbone from 01/01/2007 to 12/31/2021 were included. We used multivariable linear mixed-effects models to estimate marginal predictions of weight change over time, adjusted for age, sex assigned at birth, race/ethnicity, cohort site, ART initiation year, HIV acquisition risk, NRTI backbone, baseline HIV-1 RNA and CD4+ count, and weight at treatment start. Continuous variables were fitted using restricted cubic splines with 4 knots. Additional analyses were stratified by NRTI backbone. Results: Among 32,962 included individuals, median baseline age and BMI were 41 years and 25.4 kg/m 2 , respectively; 84% were male, and 45% were Black; 10,406 started an INSTI, 13,500 an NNRTI, and 9,056 a PI; and 72% initiated on TDF/FTC, 12% ABC/3TC, and 11% TAF/FTC. At year 2, persons on NNRTIs gained less weight (2.0 kg) than those on PIs and INSTIs (both 4.1 kg). Notably, a similar difference was observed when the analysis was limited to regimens incorporating TDF/FTC and when EFV was excluded from the NNRTIs (Fig 1A). Among INSTIs, persons starting DTG (4.7 kg) and BIC (6.1 kg) had greater weight gain at year 2, while the change for those starting EVG/c (3.5 kg) and RAL (4.0 kg) was lower. In regimens incorporating TAF/FTC, those starting EVG/c still gained less weight—though the difference was not statistically significant— compared to those on DTG or BIC (Fig 1B). Conclusions: Treatment-naïve PWH who initiated INSTI- or PI-based regimens gained more weight than those starting NNRTI-based regimens, even after adjusting for the NRTI backbone and excluding EFV. Among INSTI users, those on EVG/c with TAF/FTC gained less weight than those on DTG or BIC. These findings suggest that the previously reported differences in weight gain between ART regimens may not be entirely explained by EFV's weight-suppressive effects or its coformulation with TDF. Additionally, other agents, such as non-EFV NNRTIs and EVG/c, may also have weight-suppressive properties.

Poster Abstracts

890

Weight and Body Composition After Switch to DTG/3TC From DTG/3TC/ ABC: A Randomized Open-Label Trial Karen Brorup Heje Pedersen 1 , Magnus Soeltoft Lindhardt 1 , Andreas Knudsen 2 , Gitte Kronborg 1 , Nina Weis 1 , Anne-Mette Lebech 3 , Ole Kirk 3 , Jannik Helweg Larsen 3 , Christian Philip Fischer 1 , Ann-Brit Eg Hansen 1 , Søren Møller 1 , Hartwig R. Siebner 1 , Jens Dahlgaard Hove 1 , Jan Gerstoft 3 , Thomas Benfield 4 1 Hvidovre Hospital, Hvidovre, Denmark, 2 Copenhagen University Hospital, Copenhagen, Denmark, 3 Rigshospitalet, Copenhagen, Denmark, 4 University of Copenhagen, Copenhagen, Denmark Background: Antiretroviral therapy in people with HIV (PWH) can be associated with weight gain. Knowledge on the association of nucleoside reverse transcriptase inhibitors such as abacavir (ABC) and weight change in PWH is sparse. Here we conducted a randomized controlled parallel open-label AVERTAS trial to prospectively examine if a 48-week period of discontinuation of ABC would lead to a change in weight or body composition in PWH. Methods: Adult PWH receiving triple antiretroviral therapy with dolutegravir/ abacavir/lamivudine (DTG/ABC/3TC) were randomized 2:1 to switch to 2-drug DTG/3TC or continue their treatment. Data were collected at baseline, week 24 and week 48. The trial was powered to show a difference in weight change of 2 kg between groups. Secondary outcomes included body composition evaluated by dual-energy x-ray absorptiometry and fat distribution evaluated by visceral and subcutaneous adipose tissue by computed tomography scan, liver elastography, coronary artery calcium score, and metabolic parameters. Primary and secondary outcomes were statistically analysed using a linear mixed model in an intention-to-treat analysis (ITT) and a modified ITT analysis including complete cases who adhered to the protocol. Results: Of 81 participants, 79% were white and 86% male with a mean age of 45 years. Mean duration of HIV infection was 13.7 ± 8.2 years and (DTG/3TC: 14.5 ± 8.6 years vs. DTG/ABC/3TC: 12.2 ± 7.3 years). Treatment with DTG/ ABC/3TC prior to randomization was 4.8 ± 2.6 years (DTG/3TC: 4.9 ± 3 years vs. DTG/ABC/3TC: 4.5 ± 1.5 years). Switching from DTG/ABC/3TC to DTG/3TC had no statistically significant effect on weight at week 48 (mean difference in weight change -0.5 kg 95% confidence interval (CI): -2.5 to 1.5, p= 0.599) in the ITT analysis or -0.1 kg 95% CI: -1.7- 1.5, p=0.914) in the modified ITT analysis. In the ITT analysis the DTG/3TC group gained 0.4 kg ± 5.1 standard deviation (SD), p=0,589; and the DTG/ABC/3TC group 0.9 kg ± 2.3 SD, p= 0.054). In the modified ITT analysis weight change was 0.9±3.2 kg (p=0.054) for the DTG/ABC/3TC group and 0.9±3.6 kg (p=0.071) for the DTG/3TC. None of the secondary outcomes showed any between-group difference.

CROI 2025 276