Weight change patterns did not differ by menopause status among women switching to the integrase inhibitor (INSTI) dolutegravir compared to those who remained on their current regimen, a data re-analysis published in AIDS showed.
The BESTT trial randomized 53 virologically suppressed women (81% of whom were Black; mean age 51 years) to switch to abacavir/dolutegravir/lamivudine or remain on a regimen consisting of tenofovir disoproxil fumarate (TDF), emtricitabine (FTC), and a nonnucleoside reverse-transcriptase inhibitor (NNRTI). (The study was funded by ViiV Healthcare, the manufacturer of Triumeq.)
After 48 weeks, participants in the switch arm had gained 1.8 kg more weight, on average, than those in the control arm. Fasting plasma insulin rose in the remain arm and dropped in the switch arm. Neither measure differed by menopause status.
Waist circumference did appear to differ somewhat: Among postmenopausal women, those who switched to dolutegravir gained 1 cm. and those who remained on TDF lost 1.5 cm. By comparison, premenopausal women who switched to dolutegravir gained 2.8 cm.; those who remained on TDF gained 2 cm. Given the small number of study participants in any of the categories, however, confidence intervals were wide; all of them straddled 0 cm.
“Our data do not support the hypothesis that functional ovarian status prevents weight gain or worsening insulin resistance in women with HIV who switch [antiretroviral treatment] from TDF/FTC/NNRTI to ABC/3TC/DTG,” study authors concluded.