CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

670 GREATER WEIGHT GAIN AMONG TREATMENT-NAIVE PERSONS STARTING INTEGRASE INHIBITORS Kassem Bourgi 1 , Cathy Jenkins 1 , Peter F. Rebeiro 1 , Jordan E. Lake 2 , Richard D. Moore 3 , W. C. Mathews 4 , Michael A. Horberg 5 , Amanda Willig 6 , Michelle Floris-Moore 7 , Michael John Gill 8 , Angel M. Mayor 9 , Ronald Bosch 10 , Timothy R. Sterling 1 , John R. Koethe 1 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) for IeDEA, 1 Vanderbilt University, Nashville, TN, USA, 2 University of Texas at Houston, Houston, TX, USA, 3 Johns Hopkins University, Baltimore, MD, USA, 4 University of California San Diego, San Diego, CA, USA, 5 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA, 7 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 8 Alberta Health Services, Calgary, AB, Canada, 9 Universidad Central del Caribe, Bayamon, Puerto Rico, 10 Harvard University, Boston, MA, USA Background: Obesity among persons living with HIV (PLWH) has steadily increased in the era of combination antiretroviral therapy (ART), and some PLWH experience substantial weight gain after initiating ART that may lead to metabolic comorbidities and poorer survival. To assess the influence of antiretroviral class and integrase strand transfer inhibitors (INSTI) on this phenomenon, we compared weight changes after initiating ART among treatment-naïve PLWH in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Methods: Adult, treatment-naïve PLWH in NA-ACCORD initiating INSTI, protease inhibitor (PI), and non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based ART regimens after 01/01/2007 were included and followed through 12/31/2015. We used multivariate linear mixed effects models to generate marginal predictions of weights over time, adjusting for age, sex, race, cohort site, HIV acquisition mode, ART initiation year, and baseline weight, HIV-1 RNA, and CD4+ cell count. We used restricted cubic splines to relax linearity assumptions, multiple imputation for missing values, and bootstrapping to generate 95% confidence intervals. Predicted weights by ART class were reported at years 2 and 5. Due to shorter follow-up for newer INSTI drugs, predicted weights for raltegravir (RAL), elvitegravir (EVG), and dolutegravir (DTG) were reported at years 1 and 2. Results: Among 21,886 participants, 4,112 initiated INSTI-based regimens (2106 RAL, 1510 EVG and 477 DTG), 87%were male, and 43%were white. At ART initiation median age was 42 years, BMI was 25 kg/m², and CD4+ count was 303 cells/mm³. Weight gain was highest among PLWH starting INSTI (Figure1, A). At 2 and 5 years, PLWH on INSTI gained 4.4 and 5.8 kg, respectively, compared to 3.3 and 4.1 kg for NNRTI (p<0.001), and 4.3 and 5.0 kg for PI(p=0.68). Among PLWH starting INSTI, weight gain at year 2 was 5.6 kg for DTG, 5.4 kg for RAL, and 3.4kg for EVG (p=0.03 compared to RAL). By year 2, PLWH starting RAL (p<0.001) and DTG (p=0.01) gained significantly more weight compared to NNRTI, while those starting EVG (p=0.03) gained significantly less weight than PI (Figure1, B). Conclusion: Treatment-naïve PLWH starting INSTI, especially DTG and RAL, are at higher risk of weight gain compared to older NNRTI-class regimens. This is clinically important as INSTI-based regimens are now recommended first line ART and PLWH are at increasing risk for obesity, metabolic comorbidities, and cardiovascular disease.

671 WEIGHT GAIN DURING TREATMENT AMONG 3,468 TREATMENT- EXPERIENCED ADULTS WITH HIV Grace A. McComsey 1 , Joseph J. Eron 2 , Steven Santiago 3 , KaramMounzer 4 , Graeme Moyle 5 , Thanes Vanig 6 , Paul E. Sax 7 , Keri N. Althoff 8 , Scott Milligan 9 , Michael Marks 9 , Richard Haubrich 10 , Richard A. Elion 11 1 Case Western Reserve University, Cleveland, OH, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Care Resource, Miami, FL, USA, 4 Philadelphia FIGHT, Philadelphia, PA, USA, 5 Chelsea and Westminster Hospital, London, UK, 6 SpectrumMedical Group, Phoenix, AZ, USA, 7 Brigham and Women’s Hospital, Boston, MA, USA, 8 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 9 Trio Health, La Jolla, CA, USA, 10 Gilead Sciences, Inc, Foster City, CA, USA, 11 George Washington University, Washington, DC, USA Background: Weight gain is a known complication of HIV treatment. However, the specific risk factors and magnitude are not well understood, especially after the initial treatment period. The objectives of this study were (1) to describe the demographic, clinical, and treatment characteristics of treatment-experienced adults with virally-suppressed HIV that had ≥3% annual weight gain in recent years (2013 to 2018) and (2) to identify variables independently associated with such gain. Methods: EMR and prescription data were collected for the most recent ART exceeding 1 year in length for 3,468 previously-treated adult patients with continued HIV suppression. Patients resided in 21 States + DC and were in care at 6 HIV treatment centers. Data inclusion required ≥1 BMI at ARV prescription and ≥1 BMI during treatment but after 365 days up to 730 days. The resultant observation window was Aug 2013 to Aug 2018 and represented 5,459 patient years. Bivariate comparisons were made using chi-square or Fisher’s tests followed by independent variable assessment via logistic regression (LR). Results: Among the 3,468 adults, annualized weight gain was ≥3% for 1,045 (30%). Compared to those with <3%weight gain, the group with ≥3% gain had higher proportions of underweight and normal BMI at baseline, female, age <50, and psychiatric disorders and lower rates of comorbidities CKD, CVD, DM, hyperlipidemia, and hypogonadism. [TABLE] The weight gain patients were less commonly treated with PI-containing ART and more commonly treated with InSTI-containing ART. Factors identified as negatively associated with weight gain via LR were overweight or obese at baseline, hypogonadism, and use of PI-containing therapies. Psychiatric disorders were positively associated with weight gain via LR. InSTI-containing ART was not significantly associated with weight gain in the LR. Conclusion: Weight gain in the treatment-experienced population with continued HIV suppression was primarily associated with lower BMI, reduced proportion of hypogonadism, increased proportion of psychiatric disorders, and non-PI-containing regimens. The association between InSTI-based ART and weight gain, which reached significance in bivariate analyses, did not remain significant in LR, suggesting that in this population, weight changes are primarily driven by other factors.

Poster Abstracts

CROI 2019 256