Kerchberger AM et al. Weight gain associated with Integrase Stand Transfer Inhibitor use in women. Clinical Infectious Diseases, Published on line: 28 August 2019. https://doi.org/10.1093/cid/ciz853.                 

Integrase strand-transfer inhibitor (INSTI)-based regimens have become the primary therapies for the majority of persons with HIV disease. Several recent reports have linked these drugs to weight gain – similar to what was seen in the past with protease inhibitors. This paper is from the Women’s Interagency HIV Study (WIHS) – a cohort of 10 clinical sites in the U.S. They included 234 women enrolled from 2006 through 2017 who either switched to an INSTI or added an INSTI to their ART regimen. These women were compared to 884 women who were taking non-INSTI ART. Their mean age was approximately 49 years and 61% were black. The authors measured weight, body mass index, body fat percentage, along with waist, hip, arm, and thigh circumference. Measurements were obtained at six to twelve months before starting then six to eighteen months after starting an INSTI. Changes in measurements over time in each group were adjusted for race, age, education, smoking status, and baseline ART regimen. Compared to the women maintained on non-integrase regimens, the INSTI group experienced mean greater increases in body weight (2.1kg), BMI (0.8 kg/m²), and percent body fat (1.4%). They also had 2.0 cm, 1.9 cm, 0.6 cm, and 1.0 cm increases respectively in waist, hip, arm, and thigh circumference. All of these differences were statistically significant and affected nearly 20% of the women on an INSTI. No differences in body changes were observed by one specific integrase inhibitor compared to another. The authors note that these increases in adiposity over a short follow-up period indicate an underappreciated health impact of integrase inhibitors, especially in women, and may influence future acceptability of these ART regimens.