Weight gain and hepatic steatosis.

Tuesdayy afternoon provided a session of poster presentations exploring the complicated relationship between ARV treatment , excess weight gain and hepatic steatosis.

In summary ,

Weight gain in an HIV positive male is associated with twice the diabetes risk of the same degree of weight gain in an HIV negative male

Amit Achra from Kirby Institute presented DAD data the relationship between BMI and non AIDS related adverse outcomes. The results suggested that for CV risk both very low BMI (<18) and very high BMI (>30) were associated with an increased risk , and for non AIDS related cancers , risk was significantly associated with very low BMI and very high BMI.

An exercise physiologist from Massachusetts presented a study where overweight HIV positive patients were randomised to either be enrolled in an online weight loss and health coaching program or be in a control arm with minimal weight loss suppport. The results suggested the program was both cheap to run and successful in terms of significant weight loss.

A retrospective  analysis of a study where naive patients were randomised to start either raltegravir, boosted atazanavir or boosted darunavir plus 2 nucs looked at the predictors of excess weight gain. Interestingly they were black race , higher baseline disease severity and use of Raltegravir. There was a lot of discussion about the possible explanation of Raltegravir falling out as a predictor.

Interestingly a study was presented were HIV positive women on NNRTI or PI based regimens were randomised to either stay on th regimen or swap to Raltegravir regimen. They looked a biochemical markers of hepatic steatosis , Chi3L1 and adipokine adiponectin. It was interesting that both these markers droped (suggesting decreased steatosis) in those that switched to Raltegravir.

Finally a study looking at patients swelling from a Efavirenze containing regimen to a Raltegravir regimen appeared to decrease their steatosis as measured by a CAP score, (Controlled Attenuation Parameter , an add on process done with a fibrous scan)

So Raltegravir seemed to lead to weight gain but less hepatic steatosis , a result that seems to pose more questions than it answers.