# P-223. Changes in body mass index among people with HIV initiating integrase inhibitor based antiretroviral therapy: insights from the TriNetX database

## TL;DR

This study finds that people with HIV who start INSTI-based treatment experience a small increase in BMI compared to those on non-INSTI regimens.

## Contribution

The study provides real-world evidence linking INSTI-based ART to BMI changes using a large electronic health record database.

## Key findings

- INSTI use was associated with a 0.41 kg/m² increase in BMI compared to non-INSTI regimens.
- Weight gain was multifactorial, influenced by INSTI use, sex, follow-up duration, and TAF use.
- No significant change in BMI category was observed after adjusting for covariates.

## Abstract

Weight gain and obesity among people with HIV (PWH) is an ongoing concern and has been associated in some studies with integrase strand transfer inhibitor (INSTI) antiretroviral (ART) medications. We sought to investigate body mass index (BMI) changes among PWH initiating INSTI vs non-INSTI regimens using the nationwide TriNetX database.Table 1:Baseline CharacteristicsTable 2:Change in Body Mass Index; Adjusted Model

Baseline Characteristics

Change in Body Mass Index; Adjusted Model

TriNetX is a database of electronic medical record data abstracted from over 50 US institutions. Demographic, clinical, and laboratory data were assessed for treatment naive PWH ( >=18y) with available BMI measurements < 30 days from and closest to 12m post ART initiation. We excluded those who switched between INSTI and non-INSTI regimens during follow-up, had mixed-anchor regimens or missing/mishandled data. Bivariate and multivariable generalized linear models were used to assess potential associations between INSTI use and changes in continuous BMI and weight

5754 PWH were included (Table 1); 75.7% male (N=4357) and 42.1% Black (N=2422). Median BMI at ART initiation was 24.2 kg/m2 (IQR 21.4-28.2) and median follow-up BMI was 25.5 kg/m2 (IQR 22.3-29.8). INSTI (n=4347) and non-INSTI (n=1407) groups differed on median year of ART initiation, median duration of follow-up, median CD4 count at initiation, TAF use and TDF use with some variations in regionality (Table 1). INSTI use was associated with a statistically significant increase in BMI (+0.41kg/m2; 95% CI 0.14,0.68, p=0.003) compared to non-INSTIs however no change in BMI category was observed when adjusting for covariates (Table 2). Increased BMI was also associated with baseline BMI, sex, follow-up duration, TAF use, CD4 count at initiation and region. Weight increase for the INSTI group was 6.3% (IQR -0.6-11.7) vs 3.7% (IQR -2.7-8.8) for non-INSTIs.

INSTI use, sex, follow-up duration, and TAF use were associated with small increases in BMI, whereas TDF, EFV, baseline BMI and baseline CD4 were all associated with no change in or decreased BMI, indicating that changes in body weight are multifactorial. Future studies will compare BMI trends to non-HIV populations in order to further factors contributing to weight gain in PWH.

Ivania Rizo, MD, NovoNordisk: Advisor/Consultant Archana Asundi, MD, DayZero Diagnostics: Grant/Research Support|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Theratechnologies: Grant/Research Support|Viiv Healthcare: Grant/Research Support