1047 - Weight change associated with switching to bictegravir/emtricitabine/tenofovir alafenamide in virally suppressed people with HIV

Background: Integrase strand transfer inhibitor (INSTI) associated weight gain has been observed in a number of recent studies but with limited data on bictegravir. Here we examine weight change associated with the switch to co-formulated bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF).

Methods: We performed a retrospective analysis of consecutive PWH attending an academic outpatient clinic who received a prescription for B/F/TAF from 02/07/2018-02/07/2019 and had a baseline HIV RNA < 200 copies/mL prior to starting B/F/TAF. Baseline demographics and clinical parameters were obtained from chart review. Parameters of interest were collected for one year (at a minimum) before and one year after starting B/F/TAF. Linear mixed model analyses were conducted for PWH before/ after switch. Separate analyses were performed examining factors associated with ≥ 10% BMI increase versus < 10% increase.

Results: 156 PWH switching to B/F/TAF were identified, of whom 107 (69%) identified as men, 105 (67%) were African American. Median age was 49 years (IQR 35-57), weight 184 lb (IQR 153-208), and BMI 27.5 (IQR 23-32.3). At time of switch, 3% were underweight, 31% normal weight, 24% overweight, and 41% obese. 74% switched from INSTI-based regimen, 17% from NNRTI- and 16% from PI-based regimens. Of the INSTI, elvitegravir (54.3%) or dolutegravir (41.7%) were most frequently used. 50% were on TAF pre-switch with 28% on tenofovir disoproxil. The mixed model analysis indicated that there was not a significant shift in the mean BMI (P=0.2017) or BMI rate of change over time (P=0.792) after participants switched. 19.2% had ≥ 10% increase in BMI; and when compared to those with < 10% increase, younger age (42.8±13.8 vs. 48.9±13.2 years, P=0.036), switch from a non-PI based regimen (P=0.004), and switch from a TDF containing regimen (36.4% vs. 12.6%, P < 0.001) were associated with greater weight gain.

Conclusion: Overall, there were no significant changes in BMI between pre and post switch to B/F/TAF time periods; however the majority of PWH switched from an INSTI-based regimen. Analysis of PWH who experienced ≥ 10% increase compared to < 10% BMI increase, indicated that factors including younger age, switch from a non-PI containing regimen and switch from TDF were associated with greater weight gain.