890. Evaluation of Association Among Integrase Inhibitors for HIV Treatment, Weight Gain, and Body Image

Abstract Background Integrase inhibitors (INSTIs) are preferred antiretroviral agents for people living with HIV (PLWH). Recent studies suggest that INSTIs may contribute to weight gain and the development of metabolic syndrome. A lack of knowledge remains about how INSTIs affect metabolic parameters that contribute to weight gain as well as the impact of weight gain on medication adherence and body image in PLWH. Methods We conducted a retrospective chart review along with a real time survey of PLWH who are receiving HIV care at UConn Health. Participants who were switched to or added an INSTI to their ART regimen between 2012 - 2020 were included (n=204). Patient weight was recorded in 3-month intervals for two years prior to and two years after INSTI initiation. Lipid profile parameters and hemoglobin A1c were noted pre and post INSTI switch. A survey was administered to rate perception of weight gain, body appearance, and medication adherence on a five-point Likert scale. Statistical methods included Chi-square test and Fisher’s Exact test for categorical data, and T-test or Kruskal-Wallis test for continuous data. Results Patients started on or switched to any INSTI regimen experienced a mean weight gain of 5 and 7 pounds at 12 and 24 months, respectively (p < 0.001). Weight gain was greatest with raltegravir and elvitegravir (Figure 1,2). Bictegravir regimens resulted in a 4 pound weight loss at 24 months. An INSTI switch increased cholesterol by a mean of of 7.9mg/dL (p=0.05), with no effect on other parameters. A switch to Bictegravir increased HDL by 4mg/dL (p=0.04) and decreased triglycerides by 35mg/dL (p=0.04). Survey results showed that 100% of patients denied missing ART doses despite 69% mentioning weight gain due to ART. 97% of patients were satisfied with their ART regimen, with the majority disagreeing that their body image was negatively affected. Conclusion We demonstrate a link between INSTI use and weight gain up to two years following INSTI initiation, with the most weight gained within the first 12 months. Elvitegravir and raltegravir are associated with greater weight gain whereas bictegravir demonstrates weight loss and beneficial effects on lipid profile. Despite weight gain, most patients remained adherent and satisfied with their medication and denied negative perceptions of body image. Disclosures All Authors: No reported disclosures