Hormonal
Integrase strand transfer inhibitors (INSTIs), particularly dolutegravir and bictegravir, are the primary drivers of weight gain in modern ART regimens, with effects observed as early as 4 weeks post-initiation.
If you are taking an INSTI (like dolutegravir or bictegravir), be aware that these drugs are strongly linked to weight gain, often starting within weeks of taking them. This is a known side effect of the drug class, not just your lifestyle. If you are at high risk (e.g., woman, Black patient), discuss your concerns with your doctor. They might consider alternative regimens, though these may have other trade-offs.
Overall, it appears that dolutegravir and bictegravir, the 2 agents used largely for treatment and postexposure prophylaxis regimens, are associated with the most weight gain among the INSTI class... Dolutegravir-based regimens resulted in significant weight gain, with differences observed as early as 4 weeks post ART initiation
Why this rating
Supported by large RCTs (ADVANCE, NAMSAL) and observational studies, though mechanistic certainty is lower than clinical observation.
Source
Weight Gain After HIV Therapy Initiation: Pathophysiology and Implications
Nomathemba Chandiwana et al. · The Journal of Clinical Endocrinology & Metabolism · 2023
DOI 10.1210/clinem/dgad411
More from this paper
- Initiation of modern antiretroviral therapy (ART), specifically integrase strand transfer inhibitors (INSTIs) like dolutegravir and bictegravir combined with tenofovir alafenamide (TAF), causes significant, sustained weight gain in people living with HIV, disproportionately affecting women and Black patients.Good
- Tenofovir alafenamide (TAF) is associated with greater weight gain compared to Tenofovir disoproxil fumarate (TDF), which appears to have a weight-mitigating effect.Good
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
This is one finding among thousands. Every one is graded and traced to its source, so you can see what the evidence actually supports. Browse the research →