Updated
Reviewed
Apr. 11, 2022

Management of Medication Toxicity or Intolerance

Lipodystrophies and Weight Gain

Table 15h. Antiretroviral Therapy-Associated Adverse Effects and Management Recommendations—Lipodystrophies and Weight Gain
Table 15h. Antiretroviral Therapy-Associated Adverse Effects and Management Recommendations—Lipodystrophies and Weight Gain
   
   
   
   

See the archived version of Supplement III, February 23, 2009, Pediatric Guidelines on the Clinical info website for a more complete discussion and reference list.

References1-44

  1. Alves Junior CAS, de Lima LRA, de Souza MC, Silva DAS. Anthropometric measures associated with fat mass estimation in children and adolescents with HIV. Appl Physiol Nutr Metab. 2019;44(5):493-498. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30286302.
  2. Arbeitman LE, O’Brien RC, Somarriba G, et al. Body mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts. J Pediatr Gastroenterol Nutr. 2014;59(4):449-454. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24709829.
  3. Arpadi S, Shiau S, Strehlau R, et al. Metabolic abnormalities and body composition of HIV-infected children on lopinavir or nevirapine-based antiretroviral therapy. Arch Dis Child. 2013;98(4):258-264. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23220209.
  4. Arrive E, Viard JP, Salanave B, et al. Metabolic risk factors in young adults infected with HIV since childhood compared with the general population. PLoS One. 2018;13(11):e0206745. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30408056.
  5. Bares SH. Is modern antiretroviral therapy causing weight gain? Clin Infect Dis. 2020;71(6):1390-1392. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31608360.
  6. Bhagwat P, Ofotokun I, McComsey GA, et al. Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen: effects of sex and race. Open Forum Infect Dis. 2018;5(11):ofy201. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30465010.
  7. Bourgi K, Rebeiro PF, Turner M, et al. Greater weight gain in treatment naive persons starting dolutegravir-based antiretroviral therapy. Clin Infect Dis. 2019;70(7):1267-1274. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31100116.
  8. Cohen S, Innes S, Geelen SP, et al. Long-term changes of subcutaneous fat mass in HIV-infected children on antiretroviral therapy: a retrospective analysis of longitudinal data from two pediatric HIV-cohorts. PLoS One. 2015;10(7):e0120927. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26148119.
  9. de Castro JAC, de Lima LRA, Silva DAS. Accuracy of octa-polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in children and adolescents with HIV: comparison with dual energy X-ray absorptiometry and air displacement plethysmography. J Hum Nutr Diet. 2018;31(2):276-285. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28799180.
  10. de Medeiros R, da Silva TAL, de Oliveira ALV, et al. Influence of healthy habits counseling on biochemical and metabolic parameters in children and adolescents with HIV: longitudinal study. Nutrients. 2021;13(9). Available at: https://www.ncbi.nlm.nih.gov/pubmed/34579114.
  11. Dos Reis LC, de Carvalho Rondo PH, de Sousa Marques HH, Jose Segri N. Anthropometry and body composition of vertically HIV-infected children and adolescents under therapy with and without protease inhibitors. Public Health Nutr. 2015;18(7):1255-1261. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25115797.
  12. Eckard AR, McComsey GA. Weight gain and integrase inhibitors. Curr Opin Infect Dis. 2020;33(1):10-19. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31789693.
  13. Falutz J, Mamputu JC, Potvin D, et al. Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in human immunodeficiency virus-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. J Clin Endocrinol Metab. 2010;95(9):4291-4304. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20554713.
  14. Ferrer E, del Rio L, Martinez E, et al. Impact of switching from lopinavir/ritonavir to atazanavir/ritonavir on body fat redistribution in virologically suppressed HIV-infected adults. AIDS Res Hum Retroviruses. 2011;27(10):1061-1065. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21166602.
  15. Giacomet V, Lazzarin S, Manzo A, et al. Body fat distribution and metabolic changes in a cohort of adolescents living with HIV switched to an antiretroviral regimen containing dolutegravir. Pediatr Infect Dis J. 2021;40(5):457-459. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33847293.
  16. Gomez M, Seybold U, Roider J, Harter G, Bogner JR. A retrospective analysis of weight changes in HIV-positive patients switching from a tenofovir disoproxil fumarate (TDF)- to a tenofovir alafenamide fumarate (TAF)-containing treatment regimen in one German university hospital in 2015-2017. Infection. 2019;47(1):95-102. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30269210.
  17. Hill A, Waters L, Pozniak A. Are new antiretroviral treatments increasing the risks of clinical obesity? J Virus Erad. 2019;5(1):41-43. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30800425.
  18. Innes S, Harvey J, Collins IJ, Cotton MF, Judd A. Lipoatrophy/lipohypertrophy outcomes after antiretroviral therapy switch in children in the UK/Ireland. PLoS One. 2018;13(4):e0194132. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29617438.
  19. Kenny J, Doerholt K, Gibb DM, Judd A, Collaborative HIV Paediatric Study Steering Committee. Who gets severe gynecomastia among HIV-infected children in the United Kingdom and Ireland? Pediatr Infect Dis J. 2017;36(3):307-310. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27879556.
  20. Koay WLA, Dirajlal-Fargo S, Levy ME, et al. Integrase strand transfer inhibitors and weight gain in children and youth with perinatal human immunodeficiency virus in the DC cohort. Open Forum Infect Dis. 2021;8(7):ofab308. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34295943.
  21. Kumar S, Samaras K. The impact of weight gain during HIV treatment on risk of pre-diabetes, diabetes mellitus, cardiovascular disease, and mortality. Front Endocrinol (Lausanne). 2018;9:705. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30542325.
  22. Li J, Yusuf EH, Agwu AL. Excessive weight gain associated with dolutegravir initiation in a 10-year-old female with perinatally acquired human immunodeficiency virus: a case report and review of the literature. J Pediatric Infect Dis Soc. 2021;10(3):373-375. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32448908.
  23. Lindegaard B, Hansen T, Hvid T, et al. The effect of strength and endurance training on insulin sensitivity and fat distribution in human immunodeficiency virus-infected patients with lipodystrophy. J Clin Endocrinol Metab. 2008;93(10):3860-3869. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18628529.
  24. Lo J, You SM, Canavan B, et al. Low-dose physiological growth hormone in patients with HIV and abdominal fat accumulation: a randomized controlled trial. JAMA. 2008;300(5):509-519. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18677023.
  25. McComsey GA, Moser C, Currier J, et al. Body composition changes after initiation of raltegravir or protease inhibitors: ACTG A5260s. Clin Infect Dis. 2016;62(7):853-862. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26797215.
  26. Moure R, Domingo P, Gallego-Escuredo JM, et al. Impact of elvitegravir on human adipocytes: alterations in differentiation, gene expression and release of adipokines and cytokines. Antiviral Res. 2016;132:59-65. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27216995.
  27. Negredo E, Miro O, Rodriguez-Santiago B, et al. Improvement of mitochondrial toxicity in patients receiving a nucleoside reverse-transcriptase inhibitor-sparing strategy: results from the Multicenter Study with Nevirapine and Kaletra (MULTINEKA). Clin Infect Dis. 2009;49(6):892-900. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19663689.
  28. Norwood J, Turner M, Bofill C, et al. Brief report: weight gain in persons with HIV switched from efavirenz-based to integrase strand transfer inhibitor-based regimens. J Acquir Immune Defic Syndr. 2017;76(5):527-531. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28825943.
  29. Prendergast AJ. Complications of long-term antiretroviral therapy in HIV-infected children. Arch Dis Child. 2013;98(4):245-246. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23413313.
  30. Raboud JM, Diong C, Carr A, et al. A meta-analysis of six placebo-controlled trials of thiazolidinedione therapy for HIV lipoatrophy. HIV Clin Trials. 2010;11(1):39-50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20400410.
  31. Ramteke SM, Shiau S, Foca M, et al. Patterns of growth, body composition, and lipid profiles in a South African cohort of human immunodeficiency virus-infected and uninfected children: a cross-sectional study. J Pediatric Infect Dis Soc. 2017;7(2):143-150. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28481997.
  32. Santiprabhob J, Chokephaibulkit K, Khantee P, et al. Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors. Cytokine. 2020;136:155145. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32920318.
  33. Sax PE, Erlandson KM, Lake JE, et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis. 2020;71(6):1379-1389. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31606734.
  34. Sharma TS, Somarriba G, Arheart KL, et al. Longitudinal changes in body composition by dual-energy radiograph absorptiometry among perinatally HIV-infected and HIV-uninfected youth: increased risk of adiposity among HIV-infected female youth. Pediatr Infect Dis J. 2018;37(10):1002-1007. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29474262.
  35. Sheth SH, Larson RJ. The efficacy and safety of insulin-sensitizing drugs in HIV-associated lipodystrophy syndrome: a meta-analysis of randomized trials. BMC Infect Dis. 2010;10:183. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20573187.
  36. Spoulou V, Kanaka-Gantenbein C, Bathrellou I, et al. Monitoring of lipodystrophic and metabolic abnormalities in HIV-1 infected children on antiretroviral therapy. Hormones (Athens). 2011;10(2):149-155. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21724540.
  37. Su J, Shiau S, Arpadi SM, et al. Switch to efavirenz attenuates lipoatrophy in girls with perinatal HIV. J Pediatr Gastroenterol Nutr. 2021;72(1):e15-e20. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32804904.
  38. Taramasso L, Di Biagio A, Bovis F, et al. Switching to integrase inhibitors unlinked to weight increase in perinatally HIV-infected young adults and adolescents: a 10-year observational study. Microorganisms. 2020;8(6). Available at: https://www.ncbi.nlm.nih.gov/pubmed/32521616.
  39. Taramasso L, Ricci E, Menzaghi B, et al. Weight gain: a possible side effect of all antiretrovirals. Open Forum Infect Dis. 2017;4(4):ofx239. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29255735.
  40. Tebas P, Zhang J, Hafner R, et al. Peripheral and visceral fat changes following a treatment switch to a non-thymidine analogue or a nucleoside-sparing regimen in HIV-infected subjects with peripheral lipoatrophy: results of ACTG A5110. J Antimicrob Chemother. 2009;63(5):998-1005. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19299471.
  41. Thivalapill N, Simelane T, Mthethwa N, et al. Transition to dolutegravir is associated with an increase in the rate of body mass index change in a cohort of virally suppressed adolescents. Clin Infect Dis. 2021;73(3):e580-e586. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33119739.
  42. Tungsiripat M, Bejjani DE, Rizk N, et al. Rosiglitazone improves lipoatrophy in patients receiving thymidine-sparing regimens. AIDS. 2010;24(9):1291-1298. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20453626.
  43. Violari A, Masenya M, Blanche S, et al. The DIANA study: continued access to darunavir/ritonavir (DRV/r) and long-term safety follow-up in HIV-1-infected pediatric patients aged 3 to < 18 years. Drug Saf. 2021;44(4):439-446. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33367975.
  44. Young L, Wohl DA, Hyslop WB, Lee YZ, Napravnik S, Wilkin A. Effects of raltegravir combined with tenofovir/emtricitabine on body shape, bone density, and lipids in African-Americans initiating HIV therapy. HIV Clin Trials. 2015;16(5):163-169. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26249671.

Management of Medication Toxicity or Intolerance

Lipodystrophies and Weight Gain

Table 15h. Antiretroviral Therapy-Associated Adverse Effects and Management Recommendations—Lipodystrophies and Weight Gain
Table 15h. Antiretroviral Therapy-Associated Adverse Effects and Management Recommendations—Lipodystrophies and Weight Gain
   
   
   
   

See the archived version of Supplement III, February 23, 2009, Pediatric Guidelines on the Clinical info website for a more complete discussion and reference list.

Download Guidelines