ReviewOpen forum infectious diseases2021
Excess Weight Gain With Integrase Inhibitors and Tenofovir Alafenamide: What Is the Mechanism and Does It Matter?
Review in Open forum infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Effectiveness and safety of dolutegravir and raltegravir for treating children and adolescents living with HIV: a systematic review.Journal of the International AIDS Society · 2022Pooled it
- DEFINE: A Prospective, Randomized, Phase 4 Trial to Assess a Protease Inhibitor-Based Regimen Switch Strategy to Manage Integrase Inhibitor-Related Weight Gain.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Effect of 2 Forms of Tenofovir on Duodenal Enterocytes-A Hypothesis for Different Effect of Tenofovir Disoproxil Fumarate and Tenofovir Alafenamide on Body Weight and Plasma Lipids.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Trial
- Trial
- Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate-Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Trial
- Tenofovir alafenamide plus dolutegravir as a switch strategy in HIV-infected patients: a pilot randomized controlled trial.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2023Trial
- Changes in bone quality after switching from a TDF to a TAF based ART: A pilot randomized study.Frontiers in endocrinology · 2023Trial
- Dolutegravir population pharmacokinetics in racially, sex- and age-diverse and antiretroviral therapy-experienced adults with HIV in the United States.HIV medicine · 2026Article
- Simulation-Based Predictions to Support the Development of a Pediatric Fixed-Dose Combination of Dolutegravir/Emtricitabine/Tenofovir Alafenamide Fumarate.Clinical pharmacokinetics · 2026Review
- Cardiopulmonary Performance and Subclinical Myocardial Remodeling in Virologically Suppressed HIV Patients: The Role of the Metabolic Age Gap.International journal of molecular sciences · 2026Article
- 'Leaving no stones unturned': up to 10 years results on the effectiveness, tolerability and metabolic safety of dolutegravir+lamivudine (DTG+3TC) as a switch regimen in the ODOACRE cohort.The Journal of antimicrobial chemotherapy · 2026Observational
- Risk of obesity, diabetes, hypertension, and major adverse cardiovascular events after a switch to an integrase inhibitor: a target trial emulation in REPRIEVE.The lancet. HIV · 2026Article
- Article
- Changes in Body Mass Index in Children and Adolescents Living With Human Immunodeficiency Virus in Europe and Thailand Starting Dolutegravir.Open forum infectious diseases · 2025Article
- Tenofovir alafenamide fumarate use for HIV pre-exposure prophylaxis and weight gain.Scientific reports · 2025Article
- Article
- Differential effects of switching to integrase strand transfer inhibitors on the gut microbiota and markers of HIV disease progression.BMC microbiology · 2025Article
- Associations between weight gain, integrase inhibitors antiretroviral agents, and gut microbiome in people living with HIV: a cross-sectional study.Scientific reports · 2025Article
- Cardiometabolic Health Burden in Pediatric HIV: Unmet Need in the Contemporary Antiretroviral Therapy Era.Cureus · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Numerous studies have detected a greater likelihood of excess weight gain with specific antiretrovirals (ARVs), particularly tenofovir alafenamide and integrase inhibitors, as compared with other agents and classes. The long-term implications and potential reversibility for individuals who have experienced substantial ARV-associated weight accumulation remain poorly understood. Furthermore, the underlying mechanism remains controversial: Is the explanation mitochondrial toxicity and weight suppression from the older agents or direct effects of the newer drugs on appetite, adipocytes, or other unintended targets? This review discusses proposed mechanisms and evidence to date and argues that the question about mechanism is highly clinically relevant because it carries significant implications for ARV management. The existing literature suggests that older ARVs, such as tenofovir disoproxil fumarate and efavirenz, suppress weight gain, but also that integrase inhibitors may stimulate excess weight gain through several plausible biologic pathways. Confirming the mechanisms of ARV-associated excess weight gain should be high priority for future research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.