Effects of integrase strand transfer inhibitors (INSTIs) on body mass index and blood pressure in children living with HIV


BACKGROUND: Integrase strand transfer inhibitors (INSTIs) have been associated with excess weight gain in adults. This study assessed the effect of INSTIs on body mass index (BMI) percentile and blood pressure (BP) of children living with perinatally acquired HIV (CLWPH).
METHODS: EPIC4 prospectively enrolled and followed CLWPH from 7 Canadian centres from 2014-2018. Spline regression analysis was used to compare trends in BMI for patients with INSTI containing regimens versus age- and sex-matched INSTI naive patients. Percentages with worsening BP category (normal/elevated/stage 1/2 hypertension) were also compared using Chi-square test. Data points were assessed at time of initiation and 1 & 2 years before and after starting INSTI containing regimens.
RESULTS: 197 children (113 INSTI-exposed; 84 controls) were included, with median age 13 years at start of INSTI (range 0.4-18.5); 53% were female. 75% had normal BMI at baseline; 20% were overweight or obese, 5% were underweight. Dolutegravir, raltegravir and elvitegravir were prescribed for 33 (29%), 43 (38%), and 37 (33%), respectively. Viral load was detectable in 43/113 (39%) in INSTI group versus 9/84 (11%) in non-INSTI group at baseline, and in 7/61 (11.5%) and 13/73 (17.8%) after 2 years. Median CD4 count was 694 cells/uL in INSTI group vs 772 in non-INSTI group at baseline, and 772 vs 780 after 2 years. Comparing BMI percentile over time, modest increases in BMI percentile from baseline were noted in both groups. Regression analysis demonstrated no difference in BMI percentiles between INSTI and non-INSTI groups (p=0.276), except in those taking INSTI plus protease inhibitors (n=27; difference in change in BMI percentile compared to non-INSTI at 1 and 2 years of 0.05 [p=0.014] and 0.12 [p=0.014], respectively). Percentages with stage 1/2 hypertension were not different between INSTI vs non-INSTI over time (baseline 25% vs 17%, p=0.292; 1yr 32% vs 23%, p=0.256; 2yrs 24% vs 24%, p=0.965).
CONCLUSIONS: INSTI-containing regimens do not appear to be associated with increases in BMI percentile or BP in CLWPH in Canada.

Download the e-Poster (PDF)

Download the e-Poster (Movie)