Integrase strand transfer inhibitors, their impact in adipose tissue and weight gain in people living with HIV - A narrative review.

Greater weight gain following initiation of antiretroviral therapy (ART) with integrase strand transfer inhibitors (INsTI) compared with that seen with other classes of antiretroviral drugs, is an increasingly recognized problem in people living with HIV (PLWH). The purpose of this narrative review is to highlight those clinical trials that have documented weight gain and associated factors among PLWH on INsTI-ART. This includes the underlying pathophysiological mechanisms, toxicity, impact on adipose tissue, and how this tissue becomes metabolically dysfunctional, contributing to the emergence of insulin resistance and other comorbidities in PLWH. Considering the impact of the modern obesogenic environment and that PLWH on INsTI-ART are living longer, a coordinated approach by infectious disease specialists and other physicians to address the metabolic complications affecting this population, is imperative. The use of new anti-obesity drugs is becoming part of co-medication to limit weight gain in this population.