Integrase Strand Transfer Inhibitors and Weight Gain in Women with HIV

Integrase strand transfer inhibitors (INSTIs) are associated with more significant weight gain in women with HIV (WWH) compared to men with HIV. Menopausal transition leads to changes in body composition.

A finding published in CROI, Conference on Retroviruses and Opportunistic Infections, mentioned that switching to INSTIs during the late peri- and postmenopausal phase is associated with increased waist circumference (WC) and BMI. It was found that following this switch, peak effects occurred around 41 months.

More data is needed on whether INSTI initiation during the menopausal transition affects WC and BMI trajectories.

This study included 1159 women with HIV who were non-pregnant and virally suppressed between 2006 and 2019. Four hundred twenty-four women switched to an INSTI during the study period, while 735 did not. Nine hundred-four women without HIV (WWOH) from the Women’s Interagency HIV Study were included. The visit at which they reported switching was defined as the index visit. The researchers used mixed effect models with quadratic terms to analyze changes in waist circumference and BMI by menopausal phase, as determined by anti-Müllerian hormone levels at the index visit. This hormone is a biomarker of ovarian reserve. The models were adjusted for demographic, baseline measurements, behavioural and comorbidity, and HIV-related factors.

Key Findings from the Study

• 66% identified as Black, 28% were premenopausal, 10% were early peri-, 28% were late peri-, and 34% were postmenopausal at the index.
• INSTI+ were older than INSTI- and WWOH, with median BMIs of 30 vs 29 vs 31.5kg/m², respectively.
• 64% of INSTI+ and 79% of INSTI- were on tenofovir DF before the index visit.
• In premenopausal women, INSTI+ and INSTI—were associated with a 0.06cm per 6 months and 0.08cm per 6 months faster linear increase in WC, respectively, compared to WWOH; INSTI+ had a 0.05cm per 6 months faster increase than INSTI-.
• In late perimenopausal women, INSTI+ had faster increases in WC, which peaked at 41 months and then declined.
• INSTI—had smaller increases in WC, while INSTI+ had a 0.39cm per 6 months faster linear increase in WC than INSTI-.
• In postmenopausal women, INSTI+ was associated with faster WC increases up to 39 months, then declines compared to INSTI-.
• BMI trajectories were similar for late peri- and postmenopausal women.

Concluding further, switching to an INSTI-based regimen during late peri- and postmenopause is tied to early accelerated increases in waist circumference and BMI when compared to women who did not switch.

The results of this study suggest that menopausal status should be considered when switching to an INSTI.