Bisher AKIL, MD

Archive for November 14th, 2019|Daily archive page

HIV Treatment & Weight Gain

In General Health, HIV on November 14, 2019 at 5:44 pm

Following initiation of antiretroviral therapy (ART), many people with HIV gain weight as part of their “return to health.” However, certain antiretroviral medications, including integrase inhibitors, are associated with greater weight gain than others. Now, a manufacturer-sponsored pooled analysis of eight of the sponsor’s trials sheds light on risk factors for this weight gain.

Among 5680 people enrolled in randomized trials of initial ART between 2003 and 2015, median weight increase by week 96 was 2.0 kg. Risk factors for greater weight gain included lower baseline CD4 cell count, higher baseline HIV RNA, black race, and female sex. Participants taking integrase inhibitors (INSTIs) gained more weight than those receiving nonnucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors. Among INSTIs, weight gain was greater with bictegravir and dolutegravir than with elvitegravir/cobicistat (4.24, 4.07, and 2.72 kg, respectively). Among NNRTIs, weight gain was greater with rilpivirine than with efavirenz (3.01 vs. 1.7 kg). Among nucleoside reverse transcriptase inhibitors, weight gain was greater with tenofovir alafenamide than with abacavir, tenofovir disoproxil fumarate, or zidovudine (4.25, 3.08, 2.07, and 0.39 kg, respectively). Extreme weight gain (≥10% increase) occurred in 13% of participants in the first 48 weeks and had risk factors similar to those for weight gain overall.

Appeared in NEJM Journal Watch- edited

Citation: Sax PE et al. Weight gain following initiation of antiretroviral therapy: Risk factors in randomized comparative clinical trials. Clin Infect Dis 2019 Oct 14; [e-pub]. (


Comments: HIV infection is often associated with weight loss, particularly if left untreated after the initial infection and that has been thought to be through a mechanism that involves TNF-alpha; now with earlier detection and treatment we see less of wasting; however , newer medications have been reported to be associated with undesirable weight gain; treators have remarked on this and discussed it in meetings; this is the first study to look prospectively at this phenomenon.  Specific integrase inhibitors and tenofovir alafenamide were associated with greater increases than other ART drugs. Unfortunately, the two most effective integrase inhibitors are associated with higher weight gain than the less robust one-

Saved by the Watch?

In Heart on November 14, 2019 at 5:29 pm

The Apple Watch has an optical sensor that can detect heart rates, thus introducing the possibility of detecting atrial fibrillation (AF) [Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. At least 2.7 million Americans are living with AFib] . The industry-sponsored, prospective [forward] , open-label, siteless, pragmatic Apple Heart Study tested an algorithm to identify AF (NCT03335800). The 419,297 adult U.S. participants enrolled via an app, owned Apple Watches and iPhones, and had no prior AF.

During the study, 2161 people were notified of an irregular pulse, of whom 79% were excluded for various reasons, including 1216 who failed to attend a telemedicine visit. The researchers urgently contacted 20 people: 18 with AF and a rate >200 beats/minute, 1 with a pause >6 seconds, and 1 with non-sustained ventricular tachycardia >6 seconds.

For confirmation, electrocardiographic patches were mailed to 658 participants with nonurgent symptoms. Participants began wearing the patches about 13 days after the notification, for about 6 days. Of 450 people who returned the patches, AF was confirmed in 153 (34%); 20% had continuous AF. The yield was higher in older than younger people. Of 293,015 participants who never received a notification and who returned an end-of-study survey, 3070 reported new AF diagnoses.

As appeared in NEJM – Journal Watch – Edited.

Citations: Perez MV et al. Large-scale assessment of a smartwatch to identify atrial fibrillation. N Engl J Med 2019 Nov 14; 381:1909. (

Campion EW and Jarcho JA. Watched by Apple. N Engl J Med 2019 Nov 14; 381:1964. (


Comments: this is a large study and first of its kind; this maybe what we will see with future studies using wearable health monsters; despite its limitations (no follow up information is a big one), this remains a beginning of a potentially useful mix. Not there yet, though – BA