Stopping abacavir not linked to weight gain in HIV care

In patients with HIV infection and viral suppression, continuing or discontinuing abacavir was associated with similar modest weight gain and no significant differences in changes in body composition, fat or muscle distribution, or metabolic parameters.

METHODOLOGY:

• Researchers conducted a phase 4 randomized controlled trial to compare weight changes in patients with fully suppressed HIV infection who discontinued the nucleoside reverse transcriptase inhibitor, abacavir, compared with those who continued it.
• Overall, 81 patients (average age, 45 years; 86% men) receiving dolutegravir/abacavir/lamivudine for at least 6 months were randomly assigned to either continue the regimen (n = 26) or switch to dolutegravir/lamivudine (n = 55).
• The primary outcome was the difference in body weight change from baseline to week 48 between groups. Secondary outcomes included differences in fat distribution, overall body composition, and various metabolic parameters.

TAKEAWAY:

• At 48 weeks, the absolute weight gain in dolutegravir/abacavir/lamivudine and dolutegravir/lamivudine groups were 0.9 kg and 0.4 kg, respectively, with no significant difference between the groups (P = .599).
• Changes in fat mass, muscle mass, and bone mineral content were comparable between the groups.
• Metabolic parameters, including plasma lipid and glucose levels, A1c level, and homeostatic model assessment for insulin resistance, remained unchanged from baseline to week 48 within and between groups.
• No adverse events, severe adverse events, or suspected unexpected serious adverse reactions due to the drug regimen were reported in either group.

IN PRACTICE:

“The findings of the present study are consistent with the finding that abacavir has a neutral effect on weight,” the authors of the study wrote.

SOURCE:

This study was led by Karen Brorup Heje, Center of Clinical Research and Disruption of Infectious Diseases, Copenhagen University Hospital — Amager and Hvidovre, Hvidovre, Denmark. It was published online on September 3, 2025, in BMC Infectious Diseases.

LIMITATIONS:

This study was not blinded, introducing potential performance and observer biases. The small sample size limited the ability to detect clinically relevant changes in body weight and cumulative metabolic alterations over time. The study participants were predominantly White men with a high adherence to antiretroviral therapy, limiting the generalizability of the findings.

DISCLOSURES:

This study was supported by the Copenhagen University Hospital — Amager and Hvidovre’s Research Foundation and the Simonsen Foundation. The authors reported having no competing interests.

By Devyani Gholap