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Weighing in on the Role of Integrase Strand Transfer Inhibitors (INSTIs) on Weight Gain: Fact or Fiction?

  • HIV/AIDs (C Yoon, Section Editor)
  • Published:
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Abstract

Purpose of Review

The goal of this manuscript was to review the growing body of evidence examining the relationship between integrase strand inhibitors (INSTIs) and weight gain in treatment-naïve and treatment-experienced populations of people living with HIV. INSTIs have proven to be efficacious in virologic suppression in combination with other antiretrovirals (ARVs); however, recent data has demonstrated a potential link between weight gain and INSTIs, causing concern for risk of developing further metabolic complications. The intent of this review was to understand the magnitude of the weight gain and whether INSTIs were the sole cause.

Recent Findings

Of 71 studies conducted on this topic, 25 trials were evaluated and organized into treatment-naïve and treatment-experienced studies. While these studies were not designed homogeneously, clear patterns emerged while assessing the data. Among treatment-naïve populations, dolutegravir (DTG) generally exhibited greater levels of weight gain when compared with elvitegravir (EVG) and raltegravir (RAL). Furthermore, some studies demonstrated greater weight gain with DTG-containing groups when combined with tenofovir alafenamide (TAF). Studies in treatment-experienced patients switching to an INSTI-based regimen exhibited similar patterns. DTG was once again associated with the most weight gain in this population, with weight gain also exhibited with RAL and EVG. Due to bictegravir (BIC) being a newer agent, there was limited data in both populations.

Summary

This compilation of data suggests a link between the INSTI class and weight gain. However, it remains unclear whether weight gain occurs with INSTI initiation or long-term treatment. As more data supports the INSTI class causing weight gain, the cardiovascular and metabolic ramifications have yet to be investigated. Future research should study populations at greater risk for gaining weight, the occurrence of comorbidities associated with weight gain, and data on emerging integrase inhibitors.

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Authors and Affiliations

  1. College of Pharmacy, University of New Mexico, Albuquerque, USA

    Sarah E. Pérez

  2. OSF Saint Anthony’s Health Center, Alton, USA

    Sing Ping Chow

  3. College of Pharmacy, University of Illinois at Chicago, Chicago, USA

    Alexandra Kania & Rachel Goldberg

  4. Section of Infectious Diseases Pharmacotherapy, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, MC 886, Room 164, Chicago, IL, 60612, USA

    Melissa E. Badowski

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Correspondence to Melissa E. Badowski.

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Sarah Pérez, Sing Ping Chow, Alexandra Kania, Rachel Goldberg, and Melissa Badowski declare that they have no conflict of interest.

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Pérez, S.E., Chow, S.P., Kania, A. et al. Weighing in on the Role of Integrase Strand Transfer Inhibitors (INSTIs) on Weight Gain: Fact or Fiction?. Curr Infect Dis Rep 22, 19 (2020). https://doi.org/10.1007/s11908-020-00727-w

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