pp 1–9 | Cite as

Weight gain in antiretroviral therapy-naive HIV-1-infected patients starting a regimen including an integrase strand transfer inhibitor or darunavir/ritonavir

  • Leonardo CalzaEmail author
  • Vincenzo Colangeli
  • Marco Borderi
  • Isabella Bon
  • Aurora Borioni
  • Francesca Volpato
  • Maria Carla Re
  • Pierluigi Viale
Original Paper



Weight gain after initiation of combination antiretroviral therapy (cART) is a possible side effect of all antiretroviral regimens, but it seems to be more evident in association with integrase strand transfer inhibitors (INSTIs). So, we aimed to evaluate weight change associated with an initial cART including one INSTI or darunavir–ritonavir (DRV/r).


A retrospective, observational, cohort study of antiretroviral therapy-naive adult HIV-positive patients starting an initial cART including raltegravir (RAL), dolutegravir (DTG), elvitegravir–cobicistat (EVG), or DRV/r. We compared changes in weight and body mass index (BMI) across the four groups during a 12-month follow-up.


As a whole, 680 patients (470 males, mean age 42.1 years) were enrolled: 196 starting RAL, 174 DTG, 158 EVG/c, and 152 DRV/r. Baseline mean CD4 lymphocyte count was 455 cells/mm3 and 7.3% had an AIDS diagnosis. After 12 months, mean increase in body weight was 1.93 kg in the RAL group, 2.38 kg in the DTG group, 2.14 kg in the EVG group, and 1.85 in the DRV/r group. Mean increase in BMI was 0.71, 0.84, 0.77 and 0.63 kg/m2, respectively (p > 0.05 for each comparison). Therefore, no significant increases in weight and BMI were reported in each group, and no significant differences in weight and BMI changes were described across the four treatment groups.


In our study, patients starting an initial cART including one INSTI or DRV/r after 12 months showed a small and comparable, but not significant, increase in body weight, whose long-term clinical consequences are unknown.


Body mass index Raltegravir Dolutegravir Elvitegravir Darunavir 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Demir OM, Candilio L, Fuster D, Muga R, Barbaro G, Colombo A, et al. Cardiovascular disease burden among human immunodeficiency virus-infected individuals. Int J Cardiol. 2018;265:195–203.CrossRefGoogle Scholar
  2. 2.
    Sinha A, Feinstein MJ. Coronary artery disease manifestations in HIV: what, how, and why. Can J Cardiol. 2019;35:270–9.CrossRefGoogle Scholar
  3. 3.
    Guaraldi G, Oralndo G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011;53:1120–6.CrossRefGoogle Scholar
  4. 4.
    Rao SG, Galaviz KI, Gay HC, Wei J, Armstrong WS, del Rio C, et al. Factors associated with excess myocardial infarction risk in HIV-infected adults: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2019 Feb 20 [Epub ahead of print].Google Scholar
  5. 5.
    Lang S, Mary-Krause M, Cotte L, Gilquin J, Partisani M, Simon A, et al. French Hospital Database on HIV-ANRS CO4. Increased risk of myocardial infarction in HIV-infected patients in France, relative to the general population. AIDS. 2010;24:1228–30.CrossRefGoogle Scholar
  6. 6.
    Kumar S, Samaras K. The impact of weight gain during HIV treatment on risk of pre-diabetes, diabetes mellitus, cardiovascular disease, and mortality. Front Endocrinol (Lausanne). 2018;9:705.CrossRefGoogle Scholar
  7. 7.
    Herrin M, Tate JP, Akgün KM, Butt AA, Crothers K, Freiberg MS, et al. Weight gain and incident diabetes among HIV-infected veterans initiating antiretroviral therapy compared with uninfected individuals. J Acquir Immune Defic Syndr. 2016;73:228–36.CrossRefGoogle Scholar
  8. 8.
    Sattler FR, He J, Letendre S, Wilson C, Sanders C, Heaton R, et al. Abdominal obesity contributes to neurocognitive impairment in HIV-infected patients with increased inflammation and immune activation. J Acquir Immune Defic Syndr. 2015;68:281–8.CrossRefGoogle Scholar
  9. 9.
    Bhagwat P, Ofotokun I, McComsey GA, Brown T, Moser C, Sugar CA, et al. Predictors of severe weight/body mass index gain following antiretroviral initiation. In: [Abstract 695] 24th Conference on Retroviruses and Opportunistic Infections (CROI) 13–16 February 2017.Google Scholar
  10. 10.
    Taramasso L, Ricci E, Menzaghi B, Orofino G, Passerini S, Madeddu G, et al. Weight gain: a possible effect of all antiretrovirals. Open Forum Infect Dis. 2017;4:ofx239.CrossRefGoogle Scholar
  11. 11.
    Lakey W, Yang LY, Yancy W, Chow SC, Hicks C. Short communication: from wasting to obesity: initial antiretroviral therapy and weight gain in HIV-infected persons. AIDS Res Hum Retrovir. 2013;29:435–40.CrossRefGoogle Scholar
  12. 12.
    Erlandson KM, Kitch D, Tierney C, Sax PE, Daar ES, Tebas P, et al. Weight and lean body mass change with antiretroviral initiation and impact on bone mineral density. AIDS. 2013;27:2069–79.CrossRefGoogle Scholar
  13. 13.
    McComsey GA, Moser C, Currier J, Ribaudo HJ, Paczuski P, Dubé MP, et al. Body composition changes after initiation of raltegravir or protease inhibitors: actg A5260s. Clin Infect Dis. 2016;62:853–62.CrossRefGoogle Scholar
  14. 14.
    Bourgi K, Jenkins C, Rebeiro PF, Lake JE, Moore RD, Mathews WC, et al. Greater weight gain among treatment-naïve persons starting integrase inhibitors. In: [Abstract 670] 26th Conference on Retroviruses and Opportunistic Infections (CROI) 4–7 March 2019.Google Scholar
  15. 15.
    Menard A, Meddeb L, Tissot-Dupont H, Ravaux I, Dhiver C, Mokhtari S, et al. Dolutegravir and weight gain: an unexpected bothering side effect? AIDS. 2017;31:1499–500.CrossRefGoogle Scholar
  16. 16.
    Norwood J, Turner M, Bofill C, Rebeiro P, Shepherd B, Bebawy S, et al. Weight gain in persons with HIV switched from efavirenz-based to integrase strand transfer inhibitor-based regimens. J Acquir Immune Defic Syndr. 2017;76:527–31.CrossRefGoogle Scholar
  17. 17.
    Kerchberger AM, Sheth AN, Angert CD, Mehta CC, Summers NA, Ofotokun I, et al. Integrase strand transfer inhibitors are associated with weight gain in women. In: [Abstract 672] 26th Conference on Retroviruses and Opportunistic Infections (CROI) 4–7 March 2019.Google Scholar
  18. 18.
    Lake JE, Wu K, Erlandson KM, Bares SH, Debroy P, Godfrey C, et al. Risk factors for excess weight gain following switch to integrase inhibitor-based ART. In: [Abstract 669] 26th Conference on Retroviruses and Opportunistic Infections (CROI) 4–7 March 2019.Google Scholar
  19. 19.
    Bares SH, Smeaton LM, Xu A, Godfrey C, McComsey GA. HIV-infected women gain more weight than HIV-infected men following the initiation of antiretroviral therapy. J Womens Health (Larchmt). 2018;27:1162–9.CrossRefGoogle Scholar
  20. 20.
    Debroy P, Sim M, Erlandson KM, Falutz J, Prado CM, Brown TT, et al. Progressive increases in fat mass occur in adults living with HIV on antiretroviral therapy, but patterns differ by sex and anatomic depot. J Antimicrob Chemother. 2019;74:1028–34.CrossRefGoogle Scholar
  21. 21.
    Gomez M, Seybold U, Roider J, Harter G, Bogner JR. A retrospective analysis of weight changes in HIV-positive patients switching from a tenofovir disoproxil fumarate (TDF)- to a tenofovir alafenamide fumarate (TAF)-containing treatment regimen in one German university hospital in 2015-2017. Infection. 2019;47:95–102.CrossRefGoogle Scholar
  22. 22.
    Kouanfack C, Mpoudi-Etame M, Omgba Bassega P, Eymard-Duvernay S, Leroy S, Boyer S, NAMSAL ANRS 12313 Study Group, et al. Dolutegravir-based or low-dose efavirenz-based regimen for the treatment of HIV-1. N Engl J Med. 2019;381:816–26.CrossRefGoogle Scholar
  23. 23.
    Venter WD, Moorhouse M, Sokhela S, Fairlie L, Mashabane N, Masenya M, et al. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med. 2019;381:803–15.CrossRefGoogle Scholar
  24. 24.
    Achhra AC, Mocroft A, Reiss P, Sabin C, Ryom L, de Wit S, et al. Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A:D study. HIV Med. 2016;17:255–68.CrossRefGoogle Scholar
  25. 25.
    Yuh B, Tate J, Butt AA, Crothers K, Freiberg M, Leaf D, et al. Weight change after antiretroviral therapy and mortality. Clin Infect Dis. 2015;60:1852–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital“Alma Mater Studiorum” University of BolognaBolognaItaly
  2. 2.Microbiology Unit, S. Orsola-Malpighi Hospital“Alma Mater Studiorum” University of BolognaBolognaItaly

Personalised recommendations