Weight Trajectories Across Antiretroviral Therapy Regimen Switches in Older People With HIV in China: A Nationwide Multicenter Cohort Study

BACKGROUND: As China's HIV epidemic ages rapidly, evaluating metabolic risks in older people with HIV (PWH) is increasingly urgent. Weight gain associated with integrase strand transfer inhibitors (INSTIs) has drawn increasing attention, but data on older Chinese PWH remain scarce. METHODS: We conducted a retrospective cohort study of PWH aged ≥ 50 years across 19 cities in China within the National Free Antiretroviral Therapy Programme. We assessed weight change trajectories across antiretroviral therapy regimen switches among non-nucleoside reverse transcriptase inhibitors (NNRTIs), INSTIs, and protease inhibitors (PIs), using piecewise mixed-effects models and restricted cubic splines. We performed subgroup analyses to assess whether associations differed by sex, age, and baseline metabolic risk. RESULTS: Among 5618 participants, the adjusted weight-change slope increased from 0.41 kg/year before switching to 0.90 kg/year afterward (p = 0.03). Slope changes were +0.76 kg/year for NNRTI→INSTI (p = 0.03), +4.76 kg/year for PI→INSTI (p < 0.01), and -2.07 kg/year for INSTI→NNRTI (p = 0.03). Exploratory analyses suggested numerically stronger associations among females, adults aged ≥ 65 years, and participants with baseline metabolic risk. CONCLUSIONS: Switching to INSTI-based regimens was associated with steeper weight-gain trajectories compared to switching to other regimens, while switching from an INSTI to an NNRTI was associated with attenuation. These findings support weight and cardiometabolic monitoring after regimen changes, while decisions regarding ART modification should remain individualized.

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Journal
Journal of the American Geriatrics Society
Published
2026-11-03
DOI
https://doi.org/10.1111/jgs.70817
Primary Topic
HIV-related health complications and treatments
Type
article
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article

Weight Trajectories Across Antiretroviral Therapy Regimen Switches in Older People With HIV in China: A Nationwide Multicenter Cohort Study

Meiyin Zou, Fan Song, Lianguo Ruan, Zhongsi Hong et al.
Journal of the American Geriatrics Society
HIV-related health complications and treatments
article

Weight Trajectories Across Antiretroviral Therapy Regimen Switches in Older People With HIV in China: A Nationwide Multicenter Cohort Study

Meiyin Zou, Fan Song, Lianguo Ruan, Zhongsi Hong, Yanhua Fu, Yong Cai, Yanshan Cai, Ying Qiao, Bin Su, Li Bin Song, Lijing Wang, Fengjuan Chen, Chenrui Li, Jun Zou, Yaokai Chen, Rugang Wang, Huachun Zou, Ping Ma, Ying Wang, Hui Wang, Tong Zhang, Xiaojun Meng, Xinsheng Wu, Yuxia Song, Yong Gao
article en

Abstract

BACKGROUND: As China's HIV epidemic ages rapidly, evaluating metabolic risks in older people with HIV (PWH) is increasingly urgent. Weight gain associated with integrase strand transfer inhibitors (INSTIs) has drawn increasing attention, but data on older Chinese PWH remain scarce. METHODS: We conducted a retrospective cohort study of PWH aged ≥ 50 years across 19 cities in China within the National Free Antiretroviral Therapy Programme. We assessed weight change trajectories across antiretroviral therapy regimen switches among non-nucleoside reverse transcriptase inhibitors (NNRTIs), INSTIs, and protease inhibitors (PIs), using piecewise mixed-effects models and restricted cubic splines. We performed subgroup analyses to assess whether associations differed by sex, age, and baseline metabolic risk. RESULTS: Among 5618 participants, the adjusted weight-change slope increased from 0.41 kg/year before switching to 0.90 kg/year afterward (p = 0.03). Slope changes were +0.76 kg/year for NNRTI→INSTI (p = 0.03), +4.76 kg/year for PI→INSTI (p < 0.01), and -2.07 kg/year for INSTI→NNRTI (p = 0.03). Exploratory analyses suggested numerically stronger associations among females, adults aged ≥ 65 years, and participants with baseline metabolic risk. CONCLUSIONS: Switching to INSTI-based regimens was associated with steeper weight-gain trajectories compared to switching to other regimens, while switching from an INSTI to an NNRTI was associated with attenuation. These findings support weight and cardiometabolic monitoring after regimen changes, while decisions regarding ART modification should remain individualized.

Journal of the American Geriatrics Society
University of Science and Technology of China (CN), Xinjiang Medical University (CN), Sun Yat-sen University (CN), Shanghai Jiao Tong University (CN), Dalian Medical University (CN), Fudan University (CN), Southwest Medical University (CN), Jinyintan Hospital (CN), Southern University of Science and Technology (CN), Affiliated Hospital of Nantong University (CN), Guangzhou Center for Disease Control and Prevention (CN), The Fourth People's Hospital (CN), Urumqi 4th People's Hospital (CN), Fifth Hospital of Shijiazhuang (CN), Melbourne Sexual Health Centre (AU), Tongren Hospital (CN), Fifth Affiliated Hospital of Sun Yat-sen University (CN), Ministry of Education (KR), Guiyang University (CN), The Second Nanning People's Hospital (CN), Sixth Affiliated Hospital of Xinjiang Medical University (CN), Chongqing Public Health Medical Center (CN), Wuxi People's Hospital (CN), Shenzhen Third People’s Hospital (CN), Huazhong University of Science and Technology (CN), Monash University (AU)
Openalex Percentile: Top 11%
HIV-related health complications and treatments
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