Weight trajectories in virally suppressed people with HIV compared to matched people without HIV, and predictors of weight gain: a 3-year cohort study from the US TRIO Healthcare Network

Background: Weight gain in people with HIV (PWH) has generated concern regarding metabolic consequences of antiretroviral therapy (ART). It is unclear whether weight gain differs between virally suppressed (VS) PWH and people without HIV (PWoH) when accounting for key characteristics, or which clinical and demographic factors drive weight gain in VS PWH. Methods: This retrospective observational cohort study utilized electronic records from 12 US federally qualified health centers (January 2015-August 2023). Part A employed multi-stage propensity score matching (4:1 ratio) to compare 3-year weight trajectories adjusting for demographics, comorbidities, and medications. Part B used classification and regression trees (CART), logistic regression to identify predictors of weight gain (≥10% gain with BMI shift or baseline obesity) vs minimal gain (>0% to <5%) among 10,413 suppressed PWH. Results: In matched, adjusted analyses (1,296 VS PWH; 4,168 matched PWoH), no significant difference in mean 3-year weight change was observed between VS PWH and PWoH (0.4 kg, 95% CI: -0.1 to +0.9). A higher proportion of VS PWH gained ≥10% of baseline weight compared to PWoH (15% vs. 11%, p<0.001) and increased BMI shifts (13% vs. 11%, p=0.02). Among virally suppressed PWH, significant gain correlated with younger age (median 44 vs. 51 years), female sex (28% vs. 16%), Black race (49% vs. 37%), and lower baseline BMI. No ART regimen were associated with significant weight gain . Conclusion: Weight change in suppressed PWH are similar to those of matched PWoH. Clinical and sociodemographic characteristics, not ART regimens, correlated with 3-year gain in VS PWH.