Low CD4 counts predict excessive weight gains during first-line treatment for HIV.

Autor:	Hill A; University of Liverpool, Department of Pharmacology and Therapeutics, 70 Pembroke Place, Liverpool L69 3GF, Liverpool, UK., Tovar Sanchez T; Department of Infectious Diseases, University of Montpellier, TransVIHMI, Institute de Recherche pour le Développement, Inserm Montpellier, France., Delaporte E; Department of Infectious Diseases, University of Montpellier, TransVIHMI, Institute de Recherche pour le Développement, Inserm Montpellier, France., Sokhela S; Department of HIV, Wits Ezintsha, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa., Simmons B; Department of Health Economics, London School of Economics and Political Science, LSE Health, London, UK., Kouanfack C; Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon., Mccann K; Department of Public Health, Imperial College London, Faculty of Medicine, London, UK., Levi J; Department of Global Health, The Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany., Fairhead C; Department of Global Health, The Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany., Venter F; Department of HIV, Wits Ezintsha, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2024 Sep 03; Vol. 79 (9), pp. 2369-2378.
DOI:	10.1093/jac/dkae238
Abstrakt:	Background: Weight gain is common after antiretroviral initiation, especially among females, those of black race and lower baseline CD4, although this may potentially be due to lower baseline weight. Use of tenofovir disoproxil fumarate or efavirenz can suppress weight gain. Methods: Data were pooled from the ADVANCE (n = 1053), NAMSAL (n = 613) and WHRI001 (n = 536) trials investigating first-line regimen. Week 96 weight and body mass index (BMI) was stratified by baseline CD4. Multivariable models of weight change and incident obesity (BMI ≥30 kg/m2) were adjusted for baseline CD4, age, sex, tenofovir disoproxil fumarate, efavirenz, baseline BMI and trial. Results: Participants across all treatment arms experienced weight gain from baseline to week 96, with baseline CD4 count, baseline HIV RNA, tenofovir alafenamide and dolutegravir use, and female sex significant predictors. Mean unadjusted weight change was highest with CD4 < 100 (+8.6 kg; SD = 8.2) and lowest with CD4 ≥ 350 (+3.0 kg; SD = 6.5). This weight gain in CD4 < 100 was highest for participants on tenofovir alafenamide-inclusive treatment, such that absolute weight at week 96 was highest in the CD4 < 100 group. Although not statistically significant, obesity rate (BMI ≥ 30 kg/m2) in those taking TAF/FTC + DTG with CD4 < 100 overtook that seen in CD4 ≥ 350, despite lower baseline obesity prevalence. The unadjusted findings were corroborated in multivariable longitudinal models. Conclusions: Participants with low CD4 may demonstrate significant 'overshoot' weight gain, in addition to 'return to health', with a trend towards increased risk of obesity when initiated on TAF/FTC + DTG. Use of tenofovir disoproxil fumarate and efavirenz were associated with smaller weight gains. Effective weight management strategies are needed, especially for individuals with low baseline CD4. (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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