No evidence of rapid reversibility of tenofovir alafenamide and/or integrase strand transfer inhibitor-associated weight gain

We aimed to determine the reversibility of ≥7% weight gain (WG) within 12 months following TAF- and/or INSTI-discontinuation in people with HIV (PWH) from the Dutch ATHENA cohort. PWH with ≥7% WG within 24 months after first switch to TAF and/or INSTI whilst being virally suppressed were selected, excluding those with comorbidities/co-medication known to be associated with WG. PWH who discontinued only TAF, only INSTI or TAF+INSTI, with available follow-up weight, were included. Mean weight change in the 24 months prior to and 12 months after discontinuation was modelled using mixed-effects linear regression. Factors associated with yearly weight change were assessed using linear regression. In 115 PWH, discontinuing only TAF (n = 39), only INSTI (n = 53) or TAF+INSTI (n = 23), the adjusted mean modelled weight change in the 24 months prior to discontinuation was +4.50 kg [95%CI, 3.04-6.10], +4.80 kg [95%CI, 2.43-7.03] and +4.13 kg [95%CI, 1.50-7.13], respectively, and -1.89 kg [95%CI, -3.40 to -0.37], -1.93 kg [95%CI, -3.92 to +0.07] and -2.55 kg [95%CI, -5.80 to +0.02] in the 12 months post-discontinuation. A greater number of years since HIV diagnosis was associated with greater reversibility of WG. No associations were found between weight change post-discontinuation and changes in NRTI backbone or anchor agent at moment of discontinuation. There was no evidence of rapid reversibility of ≥7% TAF- and/or INSTI-associated WG after discontinuation of these agents. Studies of larger and more diverse populations of PWH are required to more fully understand the degree to which WG is reversible when discontinuing TAF and/or INSTI.