Body weight is influenced by an interplay of individual and environmental factors. In people with HIV (PWH), weight is also influenced by disease status with loss accompanying disease progression that is reversed with effective antiretroviral therapy (ART). Weight changes in comparative ART trials differ by regimen, with greater gains observed with the integrase strand transfer inhibitors (INSTIs) dolutegravir and bictegravir, particularly when co-administered with tenofovir alafenamide fumarate (TAF), compared to regimens that include agents such as tenofovir disoproxil fumarate (TDF) that attenuate weight gain. We review weight changes in major randomized trials of pre-exposure prophylaxis (PrEP) and initial and switch HIV therapy, highlighting the challenges to assessing the role of ART in weight change. This examination forms the basis for a model that questions assumptions regarding an association between INSTI and TAF and excessive weight gain and calls for more careful consideration of these data when making HIV treatment decisions.

中文翻译：

---

抗逆转录病毒药物和体重变化：权衡证据

体重受到个人和环境因素相互作用的影响。在艾滋病毒感染者（PWH）中，体重也受到疾病状态的影响，体重减轻会伴随疾病进展，而有效的抗逆转录病毒治疗（ART）可以逆转体重。对比 ART 试验中的体重变化因方案而异，与包含替诺福韦二吡呋酯等药物的方案相比，整合酶链转移抑制剂 (INSTI) 多替拉韦和比克替拉韦观察到的体重变化更大，特别是与富马酸替诺福韦艾拉酚胺 (TAF) 联合给药时富马酸盐（TDF）可减轻体重增加。我们回顾了暴露前预防 (PrEP) 以及初始和转换 HIV 治疗的主要随机试验中的体重变化，强调了评估 ART 在体重变化中的作用所面临的挑战。这项检查构成了一个模型的基础，该模型对 INSTI 和 TAF 与体重过度增加之间的关联假设提出质疑，并呼吁在做出 HIV 治疗决定时更仔细地考虑这些数据。