The Conference on Retroviruses and Opportunistic Infections (CROI 2023) took place in Seattle, USA last month. Here are our top three from the five-day conference:
People with a higher BMI lose more weight when changing treatment
We reported from the AIDS2020 conference how antiretroviral treatment when switching from TDF (tenofovir disoproxil fumarate) to TAF (tenofovir alafenamide) led to weight gain. During CROI2023, two new studies were presented that specifically aimed to increase understanding the possible connection between weight and TAF.
In the Netherlands, almost all people receiving HIV treatment are followed in a study called ‘ATHENA’. In an effort to find out how changing HIV treatment affects weight in people living with HIV, researchers looked more closely at TAF in combination with the class of integrase inhibitors.
The study identified 69 people who were on treatment with an integrase inhibitor and TAF, and who changed treatment. The group had increased in weight by 3.2 – 5.6 kilos in the last two years, and after they changed treatment lost 1.3 – 2.6 kilos. The biggest effect on weight was integrase inhibitors, those who were on treatment with an integrase inhibitor and switched to another class of medicine lost more weight than those who only switched from TAF to another preparation. But even just switching from TAF to another medication resulted in an average weight loss of 1.3 kilos. Noteworthy was that those with a BMI over 30 experienced far more weight loss compared to others.
Similar results emerged in the Belgian study ‘Rumba’. People with a BMI over 30 who switched from a combination of either dolutegravir/lamivudine and abacavir (Triumeq) or bictegravir/TAF/emtricitabine (Biktarvy) to the two-drug combination dolutegravir/lamivudine (Dovato) lost an average of 1 kilogram. At the same time, people who remained on a treatment of bictegravir/TAF/emtricitabine gained an average of 1.4 kilograms.
New treatments have gotten better and side effects in the form of, for example, fat accumulation around the neck and loss of fat under the soles of the feet are very rare today, but we already knew that HIV medications can affect weight and metabolism. The differences in weight gain and weight loss among different treatments should still be considered relatively small, even though differences exist. The kilos that can possibly be affected by changing treatment should be compared with other methods of managing weight, e.g. Exercise or diet. But given that today’s treatment is lifelong, even minor adjustments can make a difference in the long term, perhaps when you are already about to change treatment, also think about how the treatment affects weight.
More common with physical depression symptoms in women taking TAF and Cobicistat
The term physical depression symptoms include, among other things, sleep disturbances, changes in appetite, weight gain or loss, pain or sexual dysfunction. In a study from the United States, researchers from the Women’s Interagency HIV Study show that certain combinations of medication can contribute to physical depression symptoms in women living with HIV.
In the study, researchers followed 1,538 women who visited a clinic at least twice a year since 2014 and provided answers about their mental health. The average age was 49 years and just over two-thirds were African-American women. 27% of the women in the study had a viral load above 50 copies/ml.
After studying the women’s responses about their own well-being, the researchers were able to divide the participants into three roughly equal groups; low, high or no depression. The following three treatments were found to be associated with physical depression symptoms among women with high depression:
- TAF, emtricitabine, darunavir and cobicistat (Symtuza)
- TAF, emtricitabine, elvitegravir and cobicistat (Genvoya)
- TAF, emtricitabine, elvitegravir, darunavir and cobicistat.
Two other treatments among the same group of women at the same time showed no connection to physical symptoms of depression:
- TDF, emtricitabine and efavirenz (Atripla)
- TDF, emtricitabine and rilpivirine (Eviplera, Complera).
Among participants with low or no depression, type of treatment did not play a role in relation to physical depression symptoms. There was also nothing to show that a certain type of treatment affected mental depression symptoms.
Interesting study looking at physical depression symptoms in women living with HIV. TAF has been on the market for almost 10 years and does not have a reputation for affecting mental or physical well-being more than other medications. The main rationale when TAF was approved was to switch from the older TDF to TAF in order to decrease risk of osteoporosis. Cobicistat is a booster (increases the body’s absorption of medicine) first used in 2012. Previous studies have shown that Cobicistat also increases the absorption of TAF. Admittedly, women with already high depression had other factors that increased the vulnerability to physical depression symptoms, but for those who have a treatment consisting of TAF and Cobicistat and experience physical symptoms of depression, it may be worthwhile to pay some extra attention to the symptoms of physical depression. Finally, it is worth noting that physical depression symptoms and what we would call depression or low mood are not the same thing.
Stem cell surgery offers hope for life without HIV
A 53-year-old man in Dusseldorf, Germany now known as ‘The Dusseldorf patient’ was diagnosed in 2011 with HIV and the life-threatening cancer acute myeloid leukemia. Two years later, the man began a stem cell transplant with the intention of curing both his leukemia and HIV. The operation meant that the man underwent both chemotherapy and so-called “graft-versus-host disease”, where the body attacks itself after transplanting new organs or cells.
Today the man named Marc, has no detectable HIV and doctors consider him cured of HIV. Marc is thus one of the five unique people in the world who are considered cured of HIV with the help of a stem cell operation.
The other four people are Timothy Ray Brown (Berlin patient) who lived 13 years without HIV, Adam Castillejo (London patient) who has lived 5 years since being cured of HIV, a middle-aged woman in the USA (New York patient) with 3 years without HIV and the 63-year-old City of Hope patient who has been HIV-free for 2 years.
Comment: It is always nice to have positive news that shows that things are moving on the cure front. Knowledge about HIV and how the virus “hides” in the body increases every year. Unfortunately, the interventions where a person has been cured are often harsh and unpredictable, with other lifelong complications as a consequence. Compared to today’s treatment, the risks and cost are far too high to make this type of intervention something universal. However, we say congratulations to Marc and hope for more progress!