Can Hiv Become Resistant To Dovato
Resistance can occur when HIV changes so that a medication doesnt work as well as usual to fight it. This means that if you develop HIV resistance to Dovato, the drug will be less effective at treating your condition.
Your doctor will likely monitor your blood throughout your Dovato treatment. This is to see if the medication is working well for you. If you have concerns about developing HIV resistance to Dovato, talk with your doctor or pharmacist.
Study Design And Participants
Pooled analyses included 8 Gilead Sciencessponsored trials of participants initiating ART that satisfied the selection criteria of phase 3 stage, active-controlled design, enrollment of treatment-naive participants, and follow-up duration of at least 96 weeks the trial designs, treatment arms, and dates are provided in Supplementary Table 1. One additional trial was included in individual trial analyses but was excluded from all pooled analyses due to inadequate frequency of weight monitoring. All participants provided informed consent and trials were undertaken in accordance with the Declaration of Helsinki and approved by central or site-specific review boards or ethics committees.
Who Tends To Gain Weight With Hiv Treatment
There has been a signal from two studies that suggest the possibility of weight gain among people who have used the integrase inhibitor dolutegravir . However, those studies were done by looking back on data captured for another purpose. Such retrospective studies are useful for exploring an idea but firm conclusions cannot be drawn from them. That is why their results are only suggestive. Results from retrospective studies can be used to develop studies of a more robust statistical design.
To better explore the issue of weight gain among people using combination HIV therapy , researchers at clinics in Milan and elsewhere in Italy conducted a large observational study, assessing health-related data drawn from more than 1,000 HIV-positive people. Participants in this study used different regimens, anchored by integrase inhibitors, protease inhibitors or non-nukes. The researchers found that participants taking common combinations of HIV drugs had increases in weight and body mass index . People who were most likely to gain weight were those who were relatively thin or older prior to starting therapy.
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Which Hiv Drugs Cause Weight Gain
Some HIV drugs are more likely to cause weight gain than others. Older drugs like the nucleoside reverse transcriptase inhibitors and non-nucleoside transcriptase inhibitors generally aren’t linked to weight gain.
These medications include:
One type of NRTI, tenofovir alafenamide, does seem to cause weight gain. It is one of the drugs in the combination therapy Biktarvy.
Protease inhibitors like atazanavir , darunavir , and tipranavir may cause weight gain.
A newer group of HIV medications called integrase strand transfer inhibitors are the ones most likely to make you gain weight. These drugs include:
How much weight you put on during treatment depends on the specific drug you take. In one study, people who took tenofovir alafenamide for 2 years gained an average of 9 pounds. Those who took Ziagen gained an average of 7 pounds. But people who took Retrovir gained less than 1 pound over the same amount of time.
The Metabolic Complications Of Rising Adiposity Trends In Hiv Treatment
The enthusiasm over the improvement in HIV-associated mortality following the introduction of cART has, however, been partly diluted with concerns of cART-associated metabolic complications, including hyperlipidaemia, insulin resistance, and lipodystrophy, which accelerate the onset of type 2 diabetes mellitus and atherothrombotic cardiovascular disease . Lipodystrophy is characterised by peripheral subcutaneous lipoatrophy and central/abdominal lipohypertrophy and has been shown to increase risk of diabetes and myocardial infarction in HIV-treated populations. Whilst earlier cART medications such as nucleoside reverse transcriptase inhibitors and first-generation protease inhibitors were associated with the most clinically evident lipoatrophy and high rates of premature diabetes, longer-term data are lacking on the metabolic consequences of more modern regimens.
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Risk Factors For 10% Weight Increase In Participants Initiating Art
To understand factors associated with more extreme weight gain, we stratified the pooled trial data into individuals who gained 10% body weight over 48 weeks vs those who did not. Individuals with 10% weight gain were more likely to be female or black, have a lower baseline weight or BMI, have lower baseline CD4 cell count, and have higher baseline HIV-1 RNA .
Demographics, Baseline Weight Characteristics, and Baseline Disease Characteristics by Weight Gain Category
In multivariate regression models , lower CD4 cell count and higher HIV-1 RNA were associated with greater odds of 10% weight gain . Normal baseline BMI was associated with 10% weight gain when compared to individuals with overweight or obese baseline BMI . Female sex and black race were associated with 10% weight gain . More black women experienced 10% weight gain than non-black women .
We assessed the association between the specific third-agent drug and 10% weight gain . Compared to EFV, the initiation of BIC or DTG , EVG/c , and RPV , but not ritonavir-boosted atazanavir, was associated with an increased risk of 10% weight gain. Among the NRTIs, TAF , but not ABC or TDF, was associated with increased risk for 10% weight gain compared to ZDV. TAF was also associated with an increased risk of 10% weight gain compared with ABC and TDF .
Is Weight Gain Reversible If People Change Treatment
As the causes of weight gain are unclear, it is uncertain if changing to different antiretrovirals might slow down or reverse weight gain. It is also important to bear in mind that integrase inhibitors are preferred for first-line treatment because they are more reliable in suppressing viral load, are less likely to cause drug resistance and have fewer side effects than other antiretrovirals.
More evidence is needed on whether lifestyle changes such as diet and exercise have benefits for people who have gained weight on antiretroviral treatment.
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Metabolic Impact Of Weight Gain
Some researchers have suggested that substantial weight gain after starting antiretroviral treatment could lead to a higher risk of cardiovascular disease or diabetes. For this analysis, researchers looked for an association between > 10% weight gain and the onset of diabetes or hyperglycaemia but found no association. People who gained greater than 10% of body weight had slightly higher total cholesterol to HDL cholesterol ratios after 96 weeks but the difference is unlikely to be clinically meaningful.
Can You Prevent Weight Loss If You Have Hiv
Lifestyle and self-care measures can help with maintaining weight. These include:
- eating a healthy diet with a good balance of calories and nutrients, such as protein for building and keeping muscle mass
- working out routinely to strengthen and boost muscle mass
- seeking help from a licensed therapist for mental health support
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Weight Gain In Participants Initiating Art
In pooled analyses, the 96-week median weight gain was 2.0 kg , with the greatest rate of weight gain occurring during the initial 48 weeks . Through 96 weeks, 48.6%, 36.6%, and 17.3% of participants had at least 3%, 5%, and 10% weight increase from baseline, respectively. Weight gain was not observed in all participants 30.2% lost weight. The proportion of participants in overweight and obese BMI categories increased over time .
Risk Factors For Weight Gain
Low CD4 count and injecting drug use were the factors associated with greatest weight gain over 96 weeks of follow-up, followed by black race and baseline viral load above 100,000 copies/ml.
People with CD4 counts below 200 gained more weight than people with higher CD4 counts and gains in weight closely tracked gains in CD4 count over time. A CD4 count below 200 was also the strongest risk factor for a weight gain of at least 10% of baseline weight .
People who injected drugs gained more weight than those who did not .
People with symptomatic HIV or AIDS at baseline gained 0.51kg more than people who were asymptomatic.
Race was associated with greater weight gain than gender. Longitudinal modelling showed that black women gained more weight than black men or white women over 96 weeks.
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For Females Using Dovato
If youre able to become pregnant, your doctor will likely give you a pregnancy test before you start Dovato treatment. This is because Dovato can be harmful to a developing fetus.
Financial And Insurance Assistance
If you need financial support to pay for Dovato, or if you need help understanding your insurance coverage, help is available.
ViiV Healthcare, the manufacturer of Dovato, offers a program called the Patient Assistance Program. For more information and to find out if youre eligible for support, call 844-588-3288 or visit the program website.
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What Are The Treatments For Facial Wasting
People who lose fat in their face can use facial fillers to replace fat lost by facial wasting. Because these two different facial fillers work differently and for different lengths of time, they can be used in combination or one at a time. Both are semi-permanent solutions, administered by a dermatologist, that may require additional treatments every few years.
Are these treatments covered by insurance?
Many insurance companies do pay for lipodystrophy treatments, as do Medicare and Medicaid. If your insurance company does not, the company that manufactures Egrifta has a process that can provide patient assistance.
Is lipodystrophy still a problemeven for people who never took meds like d4T or AZT?
What should people who havent developedbut may be worried aboutlipodystrophy know?
If you have recently started HIV therapy, or are otherwise worried about developing lipodystrophy, take a waist circumference measurement . This way, youll have a baseline to compare any changes that happen to. Your doctor will also probably do some other assessments like take a baseline glucose and lipid level. Those can then be tracked every six months or so.
If you notice any changes, or your doctor does, you can be proactive and talk about diet changes or other strategies like tesamorelin for treatment. Its better to start therapy early if you can, rather than wait until it develops into more severe lipodystrophy.
What Is Hiv Weight Loss
HIV weight loss, sometimes called HIV wasting syndrome, is an unplanned weight loss of more than 10 percent of body weight with either diarrhea or weakness and fever that lasts more than 30 days.
This type of weight loss often occurs with more advanced HIV. Lean body mass tends to be lost, but weight loss may be body fat as well.
The risk of death does increase with each 1 percent increase in weight loss from baseline weight in people living with HIV. Moreover, this risk rises by 11 percent with each 1 percent increase in weight loss from the prior visit.
HIV weight loss can result from a mix of factors such as:
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What Are The Long
Weight gain soon after starting treatment in people who were previously underweight reduces the risk of death. This is an example of the return to health effect.
However, in the long term, weight gain in people with normal body weight prior to treatment may increase the risk of cardiovascular disease and diabetes .
People living with HIV are at increased risk of cardiovascular disease compared to the general population. This increased risk is especially pronounced in women and younger people.
Abdominal fat gain on antiretroviral treatment raises the risk of diabetes, as does overall weight gain . A large study of over 49,000 people followed for five years after starting treatment found that those with normal body weight at the time they started treatment had a greater risk of cardiovascular disease the more weight they gained after starting treatment . Underweight people did not have a similarly increased risk.
The ADVANCE study found that weight gain was associated with a small projected increase in the risk of developing type 2-diabetes over ten years, but the overall risk remained low . The same study did not find an increased risk of cardiovascular disease as a result of weight gain.
Obesity and diabetes are risk factors for the development of neurocognitive impairment in people living with HIV.
Darunavir Has A High Barrier To Drug Resistance
SYMTUZA® contains darunavir, which can help you keep fighting HIV with its high barrier to HIV drug resistance. Darunavir can help stop HIV from replicating. This is why treatments containing darunavir are recommended by the Department of Health and Human Services Guidelines when treatment is started immediately after an HIV diagnosis.
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The Bottom Line On Weight Gain Following Hiv Integrase Inhibitor Initiation
Dramatic increases in weight following the initiation of integrase inhibitors, especially dolutegravir or bictegravir, is a thorny problem that may prevent the use of these otherwise excellent HIV therapies. Black women seem to be at greatest risk of excess weight gain, but white women and men of all races are not immune.
The etiology of the weight gains seen in ADVANCE and other studies is not clear. The small metabolic study that found no changes in caloric intake or metabolic rate supports the contention weve heard from many of our patients experiencing weight gain on antiretrovirals: They affirm that they have not changed their diet or activity level, yet they are putting on pounds.
That particular study looked at treatment-naïve patients. A similar investigation among those with viral suppression switching to dolutegravir or bictegravir would further help us understand how diet and metabolism changes do or do not factor into excess weight gain.
Given the differences weve seen among disparate subgroups, it is highly likely that there are genetic influences on the amount of weight people gain on certain HIV therapies.
It is also notable that levels of efavirenz were not measured to correlate with the host genotypes.
Whats The Problem With Lipodystrophy
Lipodystrophy may be undesirable for cosmetic reasonsbut also for health reasons. The fat that people may lose under their skin is actually a good place for fat to be stored: Its a source of back-up energy that the body can use. The visceral fat that people with lipodystrophy gain in their abdomen is problematic. Visceral fat can cause problems with peoples metabolismlike high cholesterol, high triglycerides, cardiovascular events, and insulin resistance. People develop visceral fat around their gastrointestinal organs and the liver, and it is very difficult to get rid of. It can almost be like an additional organ that people develop, and you cant get rid of it by liposuction because its too close to peoples vital organs.
There is an emotional component to facial wasting, because it forces us to address our own vanity, as well as the very real, physical results of HIV medications, which often affect people who have had no other manifestations of the disease.
, blog author of MyFabulousDisease.com
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Hiv/aids Reduces The Absorption Of Food
Food, once eaten, is broken down by digestion into nutrients. These nutrients pass through the gut walls into the bloodstream and are transported to the organs and tissues in the body where they are needed. One of the consequences of HIV and other infections is that since the gut wall is damaged, food does not pass through properly and is consequently not absorbed.
Diarrhoea is a common occurrence in people with HIV/AIDS. When a person has diarrhoea the food passes through the gut so quickly that it is not properly digested and fewer nutrients are absorbed.
Reduced food intake and absorption lead to weight loss and malnutrition.
Dovato And Herbs And Supplements
Below are examples of herbs and supplements that can interact with Dovato.
Dovato and St. Johns wort
St. Johns wort is an herbal supplement that is sometimes used to help treat depression. St. Johns wort can lower the level of dolutegravir in your body. If this occurs, Dovato may not work as well as it should to treat your HIV.
Because of this risk, you shouldnt take St. Johns wort if youre using Dovato. It isnt known how much St. Johns wort might affect your doses of Dovato.
Your doctor should be able to recommend other ways to treat your depression or other conditions you were taking St. Johns wort for.
Dovato and calcium and iron supplements
If you take Dovato with food, you can take a calcium or iron supplement at the same time.
If you take Dovato on an empty stomach, you should take it at least 2 hours before or 6 hours after your calcium or iron supplement.
If you have questions about when to take a calcium or iron supplement while using Dovato, talk with your doctor or pharmacist.
Dovato and multivitamins
If you take Dovato with food, you can take the multivitamin at the same time.
If you take Dovato on an empty stomach, you should take it at least 2 hours before or 6 hours after your multivitamin.
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