Weighty matters in HIV

Effective treatment has resulted in an increasingly ageing population of people with HIV (PWH) in the Netherlands. Persistent inflammation puts them at increased risk of ageing-associated comorbid conditions, which may potentially also affect their risk of morbidity and mortality when faced with novel emerging health threats. This thesis explored two emerging health threats for PWH: excessive weight gain linked to the recently introduced antiretroviral agents tenofovir alafenamide (TAF) and integrase strand transfer inhibitors (INSTIs), and the impact of the SARS-CoV-2 pandemic.
In the first part, we showed that 10% of PWH in the Netherlands had a ≥10% weight gain after switching to TAF and/or an INSTI. Discontinuing TAF and/or an INSTI did not completely reverse previously gained weight.
In the second part, we observed a similar risk of SARS-CoV-2 infection between PWH and comparable controls. The use of specific antiretroviral agents in PWH was not significantly associated with the risk of incident SARS-CoV-2 infection or severe COVID-19. Moreover, mental health impacts due to social distancing were similar between PWH and controls. Further, PWH were found to mount robust vaccine-induced as well as hybrid B- and T-cell immunity following primary vaccination against SARS-CoV-2. HIV-status was not independently associated with acquisition of SARS-CoV-2 Omicron infection in people with prior vaccine-induced or hybrid immunity.
Overall, evidence is presented that TAF and INSTIs can cause excessive weight gain in some PWH and that the SARS-CoV-2 pandemic had a similar impact on people with well-controlled HIV on ART compared to comparable controls.