Exploring the Impact of Cabotegravir-Rilpivirine Long-Acting on Weight Gain, Body Composition, and Quality of Life in Adults Living with HIV

Background Integrase inhibitors have been largely associated with weight gain in people with HIV (PWH). No data are available about weight and body composition changes in PWH trated with Cabotegravir (CAB) plus Rilpivirin (RPV) long-acting (LA). Methods We conducted a prospective study on PWH who started treatment with CAB+RPV LA. In all participants a total body Dual-energy X-ray absorptiometry (DXA) scan and Bioelectrical impedance analysis (BIA) was performed at treatment start, and at 24 (±4) weeks. On the same day, viro-immunological tests, kidney, liver and thyroid function, testosterone, estrogen, and progesterone levels were measured. Participants also completed a food diary and the International Physical Activity Questionnaire (IPAQ). We analyzed changes in body composition using paired student T test or paired Wilcoxon test, as appropriate. Results We included 29 individuals, 11 female at birth and 18 male at birth, with a median age of 51.7 (48.3-58.4) years. Participants had a long history of ART, with a median length of12.3 (IQR 5.9-23.8) years and all started the CAB+RPV LA without oral lead-in. After 6 months of CAB+RPV LA treatment, no significant changes were observed in body weight, BMI, or total fat percentage. However, hip circumference significantly decreased, and DXA showed a significantly increase in Trunk/limb ratio. No significant changes were noted in BIA, and in muscle mass, handgrip strength, or overall muscle quality. Regarding metabolic and laboratory parameters, HDL levels increased significantly (p=0.007), and creatinine levels decreased. Thyroid function tests showed a statistical significant increase in free T3 and free T4,. Furthermore, no significant changes were observed in insulin levels, testosterone, or other hormonal parameters. Finally, no differences was observed about dietary and physical activity. Conclusions 24 weeks of CAB+RPV LA treatment in PWH was associated with stable body weight, BMI, and fat percentage, with a significant decrease in waist circumference and increased trunk/limb ratio, indicating fat redistribution. Importantly, no significant changes were observed in muscle mass, and function. Metabolic benefits included increased HDL with no clinically relevant hormonal changes. A decrease in creatinine levels was also found, creatinineOur data suggest that CAB+RPV LA was not associated with significant weight gain and showedh some favorable metabolic effects over 24 weeks.

Background Integrase inhibitors have been largely associated with weight gain in people with HIV (PWH). No data are available about weight and body composition changes in PWH treated with Cabotegravir (CAB) plus Rilpivirine (RPV) long-acting (LA). Methods We conducted a prospective study on patients with heart failure who started treatment with CAB+RPV LA. In all participants, a total-body Dual-energy X-ray absorptiometry (DXA) scan and Bioelectrical impedance analysis (BIA) were performed at the start of treatment and at 24 (±4) weeks. On the same day, viro-immunological tests, as well as kidney, liver, and thyroid function, testosterone, estrogen, and progesterone levels, were measured. Participants also completed a food diary and the International Physical Activity Questionnaire (IPAQ). We analyzed changes in body composition using a paired Student t-test or a paired Wilcoxon test, as appropriate. Results We included 29 individuals, 11 females at birth and 18 males at birth, with a median age of 51.7 (48.3-58.4) years. Participants had a long history of antiretroviral therapy (ART), with a median length of 12.3 years (IQR 5.9-23.8) and all started the CAB+RPV LA without an oral lead-in. After 6 months of CAB+RPV LA treatment, no significant changes were observed in body weight, BMI, or total fat percentage. However, hip circumference significantly decreased, and DXA showed a significant increase in Trunk/limb ratio. No significant changes were noted in BIA and in muscle mass, handgrip strength, or overall muscle quality. Regarding metabolic and laboratory parameters, HDL levels increased significantly (p = 0.007), while creatinine levels decreased. Thyroid function tests showed a statistically significant increase in free T3 and free T4 levels. Furthermore, no significant changes were observed in insulin levels, testosterone, or other hormonal parameters. Finally, no differences were observed between dietary and physical activity. Conclusions Twenty-four weeks of CAB+RPV LA treatment in patients with heart failure (PWH) was associated with stable body weight, BMI, and fat percentage, accompanied by a significant decrease in waist circumference and an increased trunk-to-limb ratio, indicating fat redistribution. Importantly, no significant changes were observed in muscle mass and function. Metabolic benefits included increased HDL with no clinically relevant hormonal changes. A decrease in creatinine levels was also found. Our data suggest that CAB+RPV LA was not associated with significant weight gain and exhibited some favorable metabolic effects over 24 weeks