Question
Can integrase inhibitors increase weight and can I switch back?
20 December 2020. Related: All topics, Changing treatment, COVID-19, Side effects, Support.
Earlier this year my doctor advised me to change medication from darunavir/ritonavir to the integrase inhibitor raltegravir (Isentress) as there was some evidence that the former could contribute to heart problems. I also take Truvada (tenofovir disoproxil + emtricitabine) and I am a white guy in my 50s.
Since then i have increasingly gained weight to a point i am now uncomfortable with this. I asked the doctor about this and was told that the new medication might cause this however another doctor told me that was not the case.
I have looked online and see that an integrase inhibitor can cause weight gain.
I find it hard to get a meaningful conversation with my HIV doctor, everything is rushed and the lack of care is blamed on COVID-19.
Please could you give me some advice and also is it possible to revert back to darunavir/r was taking this for over 11 years with no problem along with two other drugs – or is there the possibility of resistance if i do that?
Many thanks for your help
Answer
Hi
Thanks for your questions.
There is lots to talk about so I will take each issue separately. Sorry if this makes the answer longer though…
If your doctor was worried about heart problems then they were right about switching from darunavir/ritonavir. See this study from 2018, also referenced below. This means that switching back to darunavir/r is probably not a good idea. The same reference report that a different boosted PI – atazanavir/r – might be an option. However, treatment guidelines generally prefer integrase inhibitors over boosted combinations.
Your main question though relates to gaining weight though after switching to raltegravir. You are right that integrase inhibitors in general have been linked to increases in weight. This has only been reported in the last couple of years and is now the focus for lots of research. However, there are two cautions that might explain why different doctors are giving you different information about your own situation.
One is that weight gain is more linked to dolutegravir and bictegravir than it is to raltegravir, where weight changes were much smaller. The second is that the higher risks for weight gain with dolutegravir, for example, were gender and ethnicity, with African women gaining much more weight for example than Caucasian men.
Also, and I am sorry if this is a sensitive question, but you changed treatment and had this weight change during COVID-19. The social changes during the year have meant that many people have been much less active and also gained more weight this year.
Your email did not include any details about whether you have been less active during lock down or if your diet has changed. Even if these things didn’t change, your doctor should talk about them in order to understand the possible causes.
Your doctor will also know more about the specific changes in weight. For example, what is your normal weight and and how much has this increased? Also, how tall are you and also your age? (in order to work out your Body Mass Index (BMI).
If the meds are linked to the changes, you might be able to change to a different combination without these concerns. Anyone who changes treatment when their viral load is undetectable will not have drug resistance.
Even after changing treatment though, becoming more active and looking at your diet might also be important in trying to get back to your previous weight.
Finally, and this is very important, please tell your doctor that you need a longer consultation time to talk about this. Doctors are increasingly under pressure to see more patients with shorter times but with notice beforehand they should be able to give you more time.
Actually, the move to virtual consultations – by phone or video – has sometimes made it easier to see you doctor. If you need more time this is easier to arrange if you say this when you book your appointment.
Sometimes this is better to ask for a slot either at the start or end of the day.
Reference:
Boosted darunavir is associated with higher cardiovascular risk in D:A:D study, but not atazanavir
https://i-base.info/htb/34218
Thanks – this extra info helps a lot. It makes it possible that without realising it, the lifestyle changes from COVID (and your foot) might be the main cause of the weight gain.
You didn’t include your weight and height though – and how much your weight has increased over the year. This would be used by your doctor to look at whether the weight gain is serious enough to be a factor for heart problems itself. For example if this is several stone rather than just a few pounds.
Truvada though has been linked to bone problems because bone loss is a side effect of tenofovir disoproxil. Have you had a DEXA scan to know whether or not you might have reduced bone mineral density (BMD) and whether this is linked to the current problem in your foot?
If yes, then switching Truvada might be something that your doctor might talk about.
Thanks Simon, I have been less active as I have had time off work with a foot injury but am still exercising daily.
On another point as I say I have feet problems, four years ago my left and now my right (bone issues), I keep thinking this could be related to either the HIV playing up behind the scenes or the medication. Any thoughts on this?