INSTI-Based Antiretroviral Therapy May Be Linked to Weight Gain in HIV Patients

Strategic Insights -

A study conducted by researchers at the Southern University of Science and Technology (SUSTech) in Shenzhen, China, suggests that integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) may be associated with weight gain in people living with HIV (PLWH). The research, published in the Clinical Infectious Diseases journal, analyzed real-world data from over 5,100 PLWH who newly started ART between 2019 and May 2023 in Shenzhen, China. The study found that INSTI-based regimens, particularly those containing tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) in combination with either evitegravir (EVG) or bictegravir (BIC), were associated with greater body mass index (BMI) increases compared to those using non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens.

Key Takeaways:

  • The study included 5,102 PLWH aged 18 years or older who started ART between 2019 and May 2023 in Shenzhen, China.
  • Significant differences in BMI changes were observed among regimens, with INSTI-based regimens associated with greater BMI gain.
  • Compared to PLWH who contemporaneously used NNRTI-based regimens, those who used INSTI-based regimens 0-0.5 years after ART initiation experienced 1.27 greater BMI gain.
  • Tenofovir disoproxil fumarate (TDF) showed potential weight-neutral or weight-suppressive effects.
  • The increase in BMI associated with 3TC/DTG is particularly prominent.
  • Regimen-specific metabolic differences highlight the importance of informed HIV treatment decisions.

Statistics:

  • 5,102 PLWH were included in the study.
  • 4771 (93.5%) of the participants were men, with a median age of 31 years (IQR 26-40).
  • Significant differences in BMI changes were observed among regimens.
  • INSTI-based regimens 0-0.5 years after ART initiation experienced 1.27 greater BMI gain (95% CI 1.14 to 1.50).
  • TDF-containing regimens 0.5-1.5 years after ART initiation experienced 1.07 less BMI gain (-1.34 to -0.79).

Sources:

  • Impact of Different Integrase Strand Transfer Inhibitors On Body Mass Index Among People Living With Hiv Who Newly Started Antiretroviral Therapy In Shenzhen, China: a Real-world Data Analysis. Clinical Infectious Diseases, 2025.
  • Oxford Univ Press Inc, Journals Dept, 2001 Evans Rd, Cary, NC 27513, USA. (Oxford University Press - www.oup.com/; Clinical Infectious Diseases - cid.oxfordjournals.org)