BACKGROUND: We determined whether change in body mass index (BMI) differentially increases the risk of hypertension or dyslipidaemia in people with HIV (PLWH) receiving integrase inhibitors (INSTI) and/or tenofovir alafenamide (TAF) compared to other contemporary regimens.
METHODS: PLWH =18 years, receiving INSTIs (DTG, BIC, RAL, EVG/c), or contemporary non-INSTIs (DRV/b, ATV/b, EFV, RPV), with baseline and =2 follow-up BMI and lipid/blood pressure results were followed-up from the latest RESPOND or local cohort baseline date and censored at the earliest event date, last visit or 31/12/2021. We used multivariate Poisson regression adjusted for time-updated BMI and confounder to determine the adjusted rate ratios (aIRR) of hypertension and dyslipidaemia by time-updated ART regimens and test for interaction between BMI and ART.
RESULTS: Of the 9,704 participants without hypertension, 2977(30.7%) developed hypertension over 39993 person-years. In the unadjusted estimates, hypertension was more common with the use of INSTI with TAF or INSTI without TAF than ART without INSTI or TAF. Adjustment for time-updated BMI attenuated the risk with concurrent use of INSTI with TAF (aIRR 1.48 confidence intervals [CI], 1.31–1.68) or INSTI without TAF (1.25, 1.13–1.39) (Fig.1). Of the 5231 participants included in the dyslipidemia analysis, 2689(51.4%) developed events over 19547 person-years. In the unadjusted analysis, dyslipidaemia incidence was higher with concurrent use of TAF with INSTI or TAF alone. Adjustment for BMI attenuated dyslipidaemia risk associated with receiving TAF with INSTI (aIRR 1.21, CI 1.07–1.37), while the risk associated with TAF alone became non-significant (1.15, 0.96–1.38). Hypertension and dyslipidemia increased with increasing BMI, but the association was not different between regimens (interaction P=0.459 and 0.303, respectively).

CONCLUSIONS: In RESPOND, current use of INSTI or TAF and increases in BMI were associated with incident hypertension and dyslipidaemia. The relationship between BMI and hypertension or dyslipidaemia did not differ by ART regimen.