Assessment of Obesity and Cardiometabolic Status by Integrase Inhibitor Use in REPRIEVE: A Propensity-Weighted Analysis of a Multinational Primary Cardiovascular Prevention Cohort of People With Human Immunodeficiency Virus.

Autor: Kileel EM; Massachusetts General Hospital, Boston, Massachusetts, USA., Lo J; Massachusetts General Hospital, Boston, Massachusetts, USA., Malvestutto C; Ohio State University, Columbus, Ohio, USA., Fitch KV; Massachusetts General Hospital, Boston, Massachusetts, USA., Zanni MV; Massachusetts General Hospital, Boston, Massachusetts, USA., Fichtenbaum CJ; University of Cincinnati, Cincinnati, Ohio, USA., Overton ET; University of Alabama, Birmingham, Alabama, USA., Okeke NL; Duke University School of Medicine, Durham, North Carolina, USA., Kumar P; Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA., Joao E; Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Aberg JA; Icahn School of Medicine at Mount Sinai, New York, New York, USA., Martinez E; Hospital Clinic and University of Barcelona, Barcelona, Spain., Currier JS; University of California at Los Angeles, Los Angeles, California, USA., Douglas PS; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Ribaudo HJ; Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Grinspoon SK; Massachusetts General Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2021 Nov 20; Vol. 8 (12), pp. ofab537. Date of Electronic Publication: 2021 Nov 20 (Print Publication: 2021).
DOI: 10.1093/ofid/ofab537
Abstrakt: Background: Emerging data demonstrate that the use of integrase inhibitor (INSTI)-based antiretroviral treatment (ART) is associated with increased weight, but the cardiometabolic health consequences of increased weight remains poorly understood.
Methods: This analysis examined INSTI use (>6 months) at entry among REPRIEVE participants enrolled in High Income and Latin America/Caribbean Global Burden of Disease regions. Primary analyses used linear and logistic regression; secondary analyses used quantile regression to examine differences across the full data distribution. Characteristics of those with and without INSTI use were balanced using inverse probability of treatment weighting.
Results: Among 4500 REPRIEVE participants, 1848 were on an INSTI-based regimen at entry for an average of 2.1 ± 1.8 years. Integrase inhibitor use (vs no INSTI use) was associated with higher odds of obesity (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.4-1.9) and higher mean body mass index ([BMI] +1.5kg/m2; 95% CI, 1.0-1.9) and waist circumference (+3.6cm; 95% CI, 2.6-4.6). Differences in weight related to INSTI use were greater in the upper tails of the distribution (+3.1kg/m2 [95% CI, 1.9-4.4] at the 90th centile vs +0.7kg/m2 [95% CI, 0.2-1.2] at the 50th centile) and among women and nonwhite participants, with sex and race having an additive effect on BMI. Conversely, INSTI use was not associated with differences in glucose, low-density lipoprotein cholesterol, or higher odds of metabolic syndrome or hypertension.
Conclusions: Differences in weight and waist circumference associated with INSTI use are (1) not uniform across people with human immunodeficiency virus, (2) greatest among women and nonwhites, and (3) concentrated at the upper tails of weight distribution. These data identify at-risk subgroups for whom long-term cardiovascular disease outcomes should be carefully assessed.
(© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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