Switch to Integrase Strand Transfer Inhibitors During the Menopausal Transition Is Associated With Accelerated Body Composition Change in Women With HIV

Abstract

Background: Integrase strand transfer inhibitors (INSTIs) and the menopausal transition have been associated with body composition changes in women with human immunodeficiency virus (WWH), but their interaction is unknown.

Methods: From 2006 to 2019, 1131 virally-suppressed WWH (419 who switched to INSTI [INSTI+]; 712 who did not switch [INSTI-]) and 887 women without HIV (WWOH) from the Women's Interagency HIV Study were included. Mixed-effects models were used to evaluate change in waist circumference (WC) and body mass index (BMI) by menopausal phase defined using anti-Müllerian hormone, a biomarker of ovarian reserve.

Results: During premenopause, WWH had increases in WC (INSTI+: 0.01 cm per 6 months [95% confidence interval {CI}: -.29 to .32] and INSTI-: 0.22 cm per 6 months [95% CI: -.01 to .44]) that were not statistically significantly different from WWOH; there was also little difference by INSTI status. In late perimenopause, INSTI+ had faster increases in WC (0.37 cm per 6 months [95% CI: .15-.60]) while INSTI- had smaller increases (0.14 cm per 6 months [95% CI: -.06 to .34]) compared to WWOH. In menopause, INSTI+ had faster increases, peaking at 43 months then declining, while INSTI- had smaller increases (0.14 cm per 6 months [95% CI: -.02 to .30]). Compared to INSTI-, in late perimenopause, INSTI+ had 0.26 cm per 6 months (95% CI: .02-.50) faster linear increases in WC and in menopause, INSTI+ was associated with faster increases, peaking at 41 months.

Conclusions: Switching to an INSTI-based regimen during late perimenopause and menopause is associated with faster increases in WC when compared to women who did not switch. Menopausal status should be considered when switching to an INSTI.

Keywords: ART; BMI; HIV; menopause; waist circumference.