Weight and metabolic changes among virally-suppressed people living with HIV who switched to co-formulated bictegravir/emtricitabine/tenofovir alafenamide.

OBJECTIVE: We aimed to investigate the evolution of weight, lipid profiles, and glucose homeostasis among virally-suppressed people living with HIV (PLWH) who switched to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF).

METHODS: PLWH with viral suppression who switched to BIC/FTC/TAF between October 2019 and May 2021 were followed for 96 weeks to examine the change of weight, lipid profiles (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)), and glycated hemoglobin (HbA1c) levels.

RESULTS: 889 PLWH with an average weight of 72.1 kg at baseline were included. At week 96, over 95% of PLWH consistently maintained plasma HIV RNA load <50 copies/mL at each 24-week interval of follow-up while the weight change was small (+0.7 kg, p<0.0001), though statistically significant. Baseline levels of TC, LDL-C, HDL-C, TG, and HbA1c were 191.8 mg/dL, 114.2 mg/dL, 48.9 mg/dL, 174.3 mg/dL, and 5.31%, respectively. After 96 weeks, changes were observed in TC (-11.6 mg/dL, p<0.0001), LDL-C (-3.4 mg/dL, p=0.0084), HDL-C (+0.6 mg/dL, p=0.1089), TG (-30.2, p<0.0001), and HbA1c (+0.12%, p<0.0001). A 5% or more weight gain was associated with age of 30-40 years, normal weight at baseline, and prior use of non-integrase inhibitors or tenofovir disoproxil fumarate. Obesity was associated with development of both dyslipidemia and diabetes mellitus after switch.

CONCLUSIONS: Stable switch to BIC/FTC/TAF maintained high rates of viral suppression and had a small impact on weight and metabolic changes in virally suppressed PLWH. Follow-up of the weight and metabolic changes is warranted in PLWH on long-term antiretroviral therapy.