Weight change with antiretroviral switch from integrase inhibitor or tenofovir alafenamide-based to Doravirine-Based regimens in people with HIV

Figures & data

Table 1. Baseline Characteristics stratified by weight trajectory prior to switch.

	Overall (N = 49)	Decrease or Stable Weight Prior to Switch (N = 29)	Increase of 3% or more prior to switch (N = 20)
Age (mean (SD))	47.3 (11.7)	48.3 (12.0)	45.8 (11.3)
Male (%)	37 (75.5)	22 (75.9)	15 (75.0)
Race/Ethnicity (%)
Black, non-Hispanic	10 (20.4)	8 (27.6)	2 (10.0)
Hispanic	12 (24.5)	5 (17.2)	7 (35.0)
Other, non-Hispanic	2 (4.1)	1 (3.4)	1 (5.0)
White, non-Hispanic	25 (51.0)	15 (51.7)	10 (50.0)
Year of ART switch (%)
2019	9 (18.4)	6 (20.7)	3 (15.0)
2020	16 (32.7)	11 (37.9)	5 (25.0)
2021	18 (36.7)	7 (24.1)	11 (55.0)
2022	6 (12.2)	5 (17.2)	1 (5.0)
≥3 comorbidities (%)	20 (40.8)	14 (48.3)	6 (30.0)
Hypertension (%)	19 (38.8)	13 (44.8)	6 (30.0)
Mental health disorder (%)	17 (34.7)	11 (37.9)	6 (30.0)
Tobacco use (%)	6 (12.2)	2 (6.9)	4 (20.0)
Substance abuse (%)	4 (8.2)	3 (10.3)	1 (5.0)
Diabetes (%)
Type 1 diabetes	1 (2.0)	1 (3.4)	0 (0.0)
Type 2 diabetes	9 (18.4)	6 (20.7)	3 (15.0)
Hyperlipidemia	9 (18.4)	4 (13.8)	5 (25.0)
Liver disease (%)	7 (14.3)	6 (20.7)	1 (5.0)
Years of HIV (median [IQR])	10.00 [8.00, 19.75]	12.00 [9.00, 27.00]	9.00 [6.50, 12.50]
Viral load at ART switch (%)
≥1000 (copies/mL)	3 (6.1)	3 (10.3)	0 (0.0)
Undetectable (<200 copies/mL)	37 (75.5)	20 (69.0)	17 (85.0)
CD4 cells/mm^3 at ART switch (median [IQR])	608 [422, 860]	575 [373, 707]	668 [489, 965]
Pre-Switch Regimen (%)
BIC/TAF/FTC	27 (55.1)	17 (58.6)	10 (50.0)
DTG/3TC	2 (4.1)	0 (0.0)	2 (10.0)
DTG/ABC/3TC	5 (10.2)	4 (13.8)	1 (5.0)
DTG/FTC/TAF/RPV	1 (2.0)	1 (3.4)	0 (0.0)
DTG/TAF/FTC	12 (24.5)	5 (17.2)	7 (35.0)
EVG/COBI/FTC/TDF	1 (2.0)	1 (3.4)	0 (0.0)
FTC/TAF/RAL/DRV/Rit	1 (2.0)	1 (3.4)	0 (0.0)
Switch Regimen (%)
DOR/3TC/TDF	42 (85.7)	24 (82.8)	18 (90.0)
DOR/DRV/COBI	2 (4.1)	1 (3.4)	1 (5.0)
DOR/FTC/TAF	4 (8.2)	3 (10.3)	1 (5.0)
DRV/COBI/DOR/TDF	1 (2.0)	1 (3.4)	0 (0.0)
Switch from TAF to TDF (%)	35 (71.4)	20 (69.0)	15 (75.0)
Reason for ART switch (%; may be more than 1)
Weight gain or obesity	41 (83.7)	23 (79.3)	18 (90.0)
New comorbidity or other intolerance	7 (14.3)	6 (20.7)	1 (5.0)
Resistance	2 (4.1)	1 (3.4)	1 (5.0)
Other	4 (8.2)	3 (10.3)	1 (5.0)
BMI category 12 months prior to ART switch (%)
Healthy	6 (12.2)	4 (13.8)	2 (10.0)
Overweight	14 (28.6)	9 (31.0)	5 (25.0)
Obese	29 (59.2)	16 (55.2)	13 (65.0)
BMI category at ART switch (%)
Healthy	5 (10.2)	4 (13.8)	1 (5.0)
Overweight	13 (26.5)	9 (31.0)	4 (20.0)
Obese	31 (63.3)	16 (55.2)	15 (75.0)
Change in weight year prior to ART switch (kg; median [IQR])	2.0 [0.0, 5.0]	0.0 [-1.0, 1.0]	8.5 [4.0, 13.0]
% change in weight over year prior to ART change (%)
decrease of ≥3%	5 (10.2)
no substantial change	24 (49.0)
increase of ≥3% but < 5%	6 (12.2)
increase of ≥ 5% but < 10%	6 (12.2)
increase of ≥10%	8 (16.3)

ART: Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; BIC: Bictegravir; TAF: Tenofovir Alfenamide Fumarate; FTC: Emtricitabine; DTG: Dolutegravir; 3TC: Lamivudine; ABC: Abacavir; RPV: Rilpivirine; EVG: Elvitegravir; COBI: Cobicistat; TDF: Tenofovir Disoproxil Fumatate; RAL: Raltegravir; DRV: Darunavir; Rit: Ritonavir; BMI: Body Mass Index. Healthy BMI 18.5–24.9, Overweight BMI 25.0–29.9, Obese BMI ≥30.0.

Figure 1. Percent change in weight following ART switch at 3, 6, 9, and 12 months. Colored lines represent the change in weight over the one year prior to ART switch. Mean and standard deviations are illustrated by box plots included for each time period.

Figure 2. Differences in weight change estimates by different subgroups are shown in Forest plots. Significant (p < .05) changes from pre to post switch are indicated by the black box, and p values ≥.05 or greater are indicated by the white box on the Forest plot. Statistical significance for comparisons across categories are indicated in the right column. BMI (body mass index), NH (non-Hispanic), TAF (tenofovir alafenamide fumarate), TDF (tenofovir disoproxil fumarate).

Figure 3. Pre-ART switch weight trajectories categorized by year of ART switch. Percentage of patients categorized into percent weight change categories or no substantial change in weight based on ART switch in years 2019, 2020, 2021 or 2022.

Figure A1. Percent weight change from ART switch. Trends show percent weight change from 12 months prior to ART switch to 12 months post ART switch. Individual graphs show subgroups and trends in percent weight change between subgroups. ART: Antiretroviral therapy; BMI: Body Mass Index; N.H.: non-Hispanic; TAF: Tenofovir Alafenamide Fumarate; TDF: Tenofovir Disoproxil Fumarate; HIV: Human Immunodeficiency Virus; T2DM: Type 2 Diabetes Mellitus; HTN: Hypertension.

Table A1. PWH characteristics by more nuanced weight trajectory prior to ART switch.

	Overall	decrease of 3% or more	no substantial change in weight	increase of = > 3% & < 5%	increase of = > 5% & < 10%	increase of 10% or more
n	49	5	24	6	6	8
Age (mean (SD))	47.3 (11.7)	45.0 (10.3)	49.0 (12.4)	51.3 (11.3)	45.2 (14.1)	42.0 (8.4)
Male (%)	37 (75.5)	2 (40.0)	20 (83.3)	5 (83.3)	4 (66.7)	6 (75.0)
Race/Ethnicity (%)
Black/African American, non-Hispanic	10 (20.4)	2 (40.0)	6 (25.0)	1 (16.7)	1 (16.7)	0 (0.0)
Hispanic, regardless of race	12 (24.5)	0 (0.0)	5 (20.8)	2 (33.3)	2 (33.3)	3 (37.5)
Other, non-Hispanic	2 (4.1)	1 (20.0)	0 (0.0)	1 (16.7)	0 (0.0)	0 (0.0)
White/Caucasian, non-Hispanic	25 (51.0)	2 (40.0)	13 (54.2)	2 (33.3)	3 (50.0)	5 (62.5)
Year of ART switch (%)
2019	9 (18.4)	1 (20.0)	5 (20.8)	0 (0.0)	2 (33.3)	1 (12.5)
2020	16 (32.7)	1 (20.0)	10 (41.7)	2 (33.3)	1 (16.7)	2 (25.0)
2021	18 (36.7)	3 (60.0)	4 (16.7)	4 (66.7)	2 (33.3)	5 (62.5)
2022	6 (12.2)	0 (0.0)	5 (20.8)	0 (0.0)	1 (16.7)	0 (0.0)
3 or more comorbidity classes (%)	20 (40.8)	1 (20.0)	13 (54.2)	2 (33.3)	2 (33.3)	2 (25.0)
Hypertension (%)	19 (38.8)	1 (20.0)	12 (50.0)	1 (16.7)	2 (33.3)	3 (37.5)
Mental health disorder (%)	17 (34.7)	2 (40.0)	9 (37.5)	2 (33.3)	3 (0.0)	1 (12.5)
Tobacco use (%)	6 (12.2)	1 (20.0)	1 (4.2)	2 (33.3)	0 (0.0)	2 (25.0)
Substance abuse (%)	4 (8.2)	1 (20.0)	2 (8.3)	0 (0.0)	1 (16.7)	0 (0.0)
Diabetes (%)
Not diabetic	35 (71.4)	4 (80.0)	15 (62.5)	4 (66.7)	5 (83.3)	7 (87.5)
pre-diabetes	4 (8.2)	0 (0.0)	3 (12.5)	0 (0.0)	0 (0.0)	1 (12.5)
Type 1 diabetes	1 (2.0)	0 (0.0)	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)
Type 2 diabetes	9 (18.4)	1 (20.0)	5 (20.8)	2 (33.3)	1 (16.7)	0 (0.0)
Hyperlipidemia	9 (18.4)	0 (0.0)	4 (16.7)	2 (33.3)	2 (33.3)	1 (12.5)
Liver disease (%)	7 (14.3)	0 (0.0)	6 (25.0)	1 (16.7)	0 (0.0)	0 (0.0)
Prescription for weight loss medication (%)	3 (6.1)	0 (0.0)	2 (8.3)	1 (16.7)	0 (0.0)	0 (0.0)
Years of HIV (median [IQR])	10.0 [8.0, 19.8]	9.0 [9.0, 13.0]	13.0 [9.5, 28.5]	12.5 [8.5, 16.5]	9.5 [8.3, 13.8]	7.0 [5.5, 8.5]
Viral load at ART switch (%)
<1000	8 (16.3)	1 (20.0)	4 (16.7)	1 (16.7)	0 (0.0)	2 (25.0)
> = 1000	3 (6.1)	1 (20.0)	2 (8.3)	0 (0.0)	0 (0.0)	0 (0.0)
Missing	1 (2.0)	0 (0.0)	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)
Undetectable (<200 copies/mL)	37 (75.5)	3 (60.0)	17 (70.8)	5 (83.3)	6 (100.0)	6 (75.0)
CD4 copies/mm^3 at ART switch (median [IQR])	608.0 [421.0, 859.8]	556.0 [390.0, 814.0]	578.0 [355.0, 697.5]	617.0 [259.8, 765.0]	963.0 [573.8, 1134.0]	665.0 [539.5, 888.0]
Regimen 1 (%)
BIC/TAF/FTC	27 (55.1)	5 (100.0)	12 (50.0)	3 (50.0)	4 (66.7)	3 (37.5)
DTG/3TC	2 (4.1)	0 (0.0)	0 (0.0)	1 (16.7)	0 (0.0)	1 (12.5)
DTG/ABC/3TC	5 (10.2)	0 (0.0)	4 (16.7)	0 (0.0)	0 (0.0)	1 (12.5)
DTG/FTC/TAF/RPV	1 (2.0)	0 (0.0)	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)
DTG/TAF/FTC	12 (24.5)	0 (0.0)	5 (20.8)	2 (33.3)	2 (33.3)	3 (37.5)
EVG/COB/FTC/TDF	1 (2.0)	0 (0.0)	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)
FTC/TAF/RAL/DRV/Rat	1 (2.0)	0 (0.0)	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)
Regimen 2 (%)
DOR/3TC/TDF	42 (85.7)	5 (100.0)	19 (79.2)	5 (83.3)	6 (100.0)	7 (87.5)
DOR/DRV/COBI	2 (4.1)	0 (0.0)	1 (4.2)	1 (16.7)	0 (0.0)	0 (0.0)
DOR/FTC/TAF	4 (8.2)	0 (0.0)	3 (12.5)	0 (0.0)	0 (0.0)	1 (12.5)
DRV/COBI/DOR/TDF	1 (2.0)	0 (0.0)	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)
Switching from TAF to TDF (%)	35 (71.4)	5 (100.0)	15 (62.5)	4 (66.7)	6 (100.0)	5 (62.5)
Reason for ART switch (%; may be more than 1)
Weight gain or obesity	41 (83.7)	3 (60.0)	20 (83.3)	5 (83.3)	6 (100.0)	7 (87.5)
New comorbidity or other intolerance	7 (14.3)	1 (20.0)	5 (20.8)	1 (16.7)	0 (0.0)	0 (0.0)
Resistance	2 (4.1)	0 (0.0)	1 (4.2)	1 (16.7)	0 (0.0)	0 (0.0)
Other	4 (8.2)	1 (20.0)	2 (8.3)	0 (0.0)	0 (0.0)	1 (12.5)
BMI category 12 months prior to ART switch (%)
Healthy	6 (12.2)	2 (40.0)	2 (8.3)	1 (16.7)	1 (16.7)	0 (0.0)
Overweight	14 (28.6)	1 (20.0)	8 (33.3)	2 (33.3)	0 (0.0)	3 (37.5)
Obese	29 (59.2)	2 (40.0)	14 (58.3)	3 (50.0)	5 (83.3)	5 (62.5)
BMI category at ART switch (%)
Healthy	5 (10.2)	2 (40.0)	2 (8.3)	0 (0.0)	1 (16.7)	0 (0.0)
Overweight	13 (26.5)	1 (20.0)	8 (33.3)	3 (50.0)	0 (0.0)	1 (12.5)
Obese	31 (63.3)	2 (40.0)	14 (58.3)	3 (50.0)	5 (83.3)	7 (87.5)
Change in weight year prior to ART switch (kg; median [IQR])	2.00 [0.0, 5.0]	−4.0 [−5.0, −3.0]	0.0 [−1.0, 1.3]	3.0 [3.0, 3.8]	7.5 [5.5, 8.8]	15.0 [12.8, 24.3]
% Change in weight over year prior to ART change (%)
decrease of 3% or more	5 (10.2)	5 (100.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
no substantial change in weight	24 (49.0)	0 (0.0)	24 (100.0)	0 (0.0)	0 (0.0)	0 (0.0)
increase of = > 3% & < 5%	6 (12.2)	0 (0.0)	0 (0.0)	6 (100.0)	0 (0.0)	0 (0.0)
increase of = > 5% & < 10%	6 (12.2)	0 (0.0)	0 (0.0)	0 (0.0)	6 (100.0)	0 (0.0)
increase of 10% or more	8 (16.3)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	8 (100.0)

ART: Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; BIC: Bictegravir; TAF: Tenofovir Alfenamide Fumarate; FTC: Emtricitabine; DTG: Dolutegravir; 3TC: Lamivudine; ABC: Abacavir; RPV: Rilpivirine; EVG: Elvitegravir; COBI: Cobicistat; TDF: Tenofovir Disoproxil Fumatate; RAL: Raltegravir; DRV: Darunavir; Rit: Ritonavir; BMI: Body Mass Index. Healthy BMI 18.5–24.9, Overweight BMI 25.0–29.9, Obese BMI ≥30.0.

Table A2. Pre-ART weight change characteristic testing.

Categorical Variables	Subgroup	Median [IQR] % Weight Change Prior to ART Switch	Group Comparison p-value
Sex at birth	Female	0% [−2.3%, 6.6%]
	Male	2.2% [0%, 5.4%]	.46
Ethnicity	Hispanic	3.5% [0.8%, 9.4%]
	Non-Hispanic	1.3% [−0.9%, 4.1%]	.15
Year of ART Switch	2019 − 2020	0.1% [0%, 3.7%]
	2021	3.7% [−1%, 10.7%]
	2022-2023	1.1 [−0.7%, 2.5%]	.54
Continuous Variables		Correlation with % Weight Change Prior to ART Switch	Correlation p-value
Age		−0.1	.58
Years of HIV infection		−0.3	.06
BMI		0.3	.05

ART: Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; BMI: Body Mass Index.

Table A3. Results of sensitivity analyses.

		Remove Extreme Weight Trajectories (N = 2  loss of >15%; N = 1 gained >15%)		Remove Weight Medication Use (N = 2  weight gain meds; N = 11 weight loss meds)		Remove Virological Failures (N = 2)
Test	Subgroup	% Weight Change 1 Year Post- ART Switch	Difference Between Subgroups at 1 Year	% Weight Change 1 Year Post- ART Switch	Difference Between Subgroups at 1 Year	% Weight Change 1 Year Post- ART Switch	Difference Between Subgroups at 1 Year
EHR Sex	Male	−2.6% (−4.0%, −1.2%); p: <.001		−3.1% (−4.9%, −1.2%); p: .002		−2.9% (−4.5%, -1.3%); p: <.001
	Female	−1.7% (−6.3%, 3.0%); p: .44	T-test p-value: .66	0.78% (−10.3%, 11.9%); p: .87	T-test p-value: .53	−0.62% (−8.61%, 7.37%); p: .87	T-test p-value: .64
Race/Ethnicity	Black/African American, non-Hispanic	−1.8% (−4.1%, 0.6%); p: .12		3.2% (−8.2%, 14.6%); p: .52		1.4% (−6.1%, 8.9%); p: .68
	Hispanic, regardless of race	−1.9% (−4.6%, 0.7%); p: .14		−3.1% (−7.6%, 1.5%); p: .16		−2.8% (−6.6%, 1.0%); p: .14
	White, non-Hispanic (reference)	−2.8% (−5.3%, −0.4%); p: .023	Anova p-value: .76	−3.6% (−7.0%, −0.2%); p: .039	Anova p-value: .19	−3.7% (−6.6%, -0.9%); p: .013	Anova p-value: .21
Year of ART Regimen Switch	2021	−4.7% (−6.8%, −2.6%); p: <.001		−5.7% (−8.7%, −2.6%); p: .002		−5.3% (−7.8%, −2.8%); p: <.001
	non-2021	−1.0% (−2.7%, 0.7%); p: .25	T-test p-value: .007	−0.1% (−3.8%, 3.7%); p: .96	T-test p-value: .02	−0.7% (−3.7%, 2.4%); p: .66	T-test p-value: .02
Switch from TAF to TDF	TAF to TDF	−1.6% (−3.3%, 0.1%); p: .07		−0.3% (−3.4%, 2.7%); p: .82		−0.7% (−3.2%, 1.8%); p: .58
	Other	−4.6% (−6.6%, −2.6%); p: <.001	T-test p-value: .025	−7.2% (−12.0%, −2.4%); p: .008	T-test p-value: .02	−7.1% (−10.9%, −3.3%); p: .002	T-test p-value: .0079
Weight Change 1 Year Prior to ART Switch	Weight increase of 3% or more	−2.8% (−5.3%, −0.4%); p: .027		−4.2% (−7.9%, −0.4%); p: .032		−4.3% (−7.6%, −1.0%); p: .015
	Stable or decreasing weight	−2.1% (−3.8%, −0.3%); p: .024	T-test p-value: .59	−0.5% (−4.4%, 3.4%); p: .78	T-test p-value: .17	−1% (−4.0%, 1.9%); p: .49	T-test p-value: .13
CD4 Category at ART Switch	<600 cells/mm^3	−1.2% (−3.2%, 0.9%); p: 0.24		0.48% (−3.67%, 4.64%); p: .81		0.51% (−3.19%, 4.2%); p: .78
	600 or greater cells/mm^3	−3.48% (−5.45%, −1.51%); p: .001	T-test p-value: .095	−4.8% (−8.1%, −1.5%); p: .007	T-test p-value: .05	−4.6% (−7.1%, −2.2%); p: <.001	T-test p-value: .02
BMI Category at Time of ART Switch	Healthy (BMI 18.5-24.9)	−1.8% (−4.2%, 0.7%); p: .11		−1.8% (−5.4%, 1.8%); p: .21		−2.3% (−5.3%, 0.7%); p: .09
	Overweight (BMI 25.0-29.9)	−1.8% (−3.8%, 0.2%); p: .07		1% (−5.1%, 7.1%); p: .73		0.6% (−5.0%, 6.3%); p: .81
	Obese (BMI ≥30.0)	−2.7% (−4.8%, −0.6%); p: 0.014	Anova p−value: 0.79	−3.9% (−7.3%, −0.5%); p: 0.025	Anova p−value: 0.24	−3.6% (−6.1%, −1.1%); p: 0.007	Anova p-value: 0.23

HER: Electronic Health Record; ART: Antiretroviral Therapy; TAF: Tenofovir Alafenamide Fumarate; TDF: Tenofovir Disoproxil Fumarate; BMI: Body Mass Index. BMI Categories: Healthy BMI 18.5–24.9, Overweight BMI 25.0–29.9, Obese BMI ≥30.0.

Table A4. PWH characteristics stratified by 2021 year of switch.

		Overall	non-2021	2021
n		49	31	18
Age (mean (SD))		47.3 (11.7)	48.5 (12.0)	45.2 (11.1)
Male (%)		37 (75.5)	23 (74.2)	14 (77.8)
Race/Ethnicity (%)
	Black/African American, non-Hispanic	10 (20.4)	8 (25.8)	2 (11.1)
	Hispanic, regardless of race	12 (24.5)	5 (16.1)	7 (38.9)
	Other, non-Hispanic	2 (4.1)	0 (0.0)	2 (11.1)
	White/Caucasian, non-Hispanic	25 (51.0)	18 (58.1)	7 (38.9)
Year of ART switch (%)
	2019	9 (18.4)	9 (29.0)	0 (0.0)
	2020	16 (32.7)	16 (51.6)	0 (0.0)
	2021	18 (36.7)	0 (0.0)	18 (100.0)
	2022	6 (12.2)	6 (19.4)	0 (0.0)
3 or more comorbidity classes (%)		20 (40.8)	15 (48.4)	5 (27.8)
Hypertension (%)		19 (38.8)	14 (45.2)	5 (27.8)
Mental health disorder (%)		17 (34.7)	11 (35.5)	6 (33.3)
Tobacco use (%)		6 (12.2)	1 (3.2)	5 (27.8)
Substance abuse (%)		4 (8.2)	3 (9.7)	1 (5.6)
Diabetes (%)
	Not diabetic	35 (71.4)	20 (64.5)	15 (83.3)
	Pre-diabetes	4 (8.2)	3 (9.7)	1 (5.6)
	Type 1 diabetes	1 (2.0)	1 (3.2)	0 (0.0)
	Type 2 diabetes	9 (18.4)	7 (22.6)	2 (11.1)
Hyperlipidemia		9 (18.4)	7 (22.6)	2 (11.1)
Liver disease (%)		7 (14.3)	6 (19.4)	1 (5.6)
Prescription for weight loss medication (%)		3 (6.1)	1 (3.2)	2 (11.1)
Years of HIV (median [IQR])		10.0 [8.0, 19.8]	11.0 [7.5, 25.0]	9.00 [8.0, 13.0]
Years of HIV prior to ART switch (median [IQR])		8.00 [4.0, 18.8]	9.0 [3.5, 23.0]	7.0 [6.0, 11.0]
Viral load at ART switch (%)
	<1000	8 (16.3)	6 (19.4)	2 (11.1)
	> = 1000	3 (6.1)	2 (6.5)	1 (5.6)
	Missing	1 (2.0)	1 (3.2)	0 (0.0)
	Undetectable (<200 copies/mL)	37 (75.5)	22 (71.0)	15 (83.3)
CD4 copies/mm^3 at ART switch (median [IQR])		608.0 [421.5, 859.8]	564.5 [337.5, 715.5]	667.5 [560.5, 869.3]
Regimen 1 (%)
	BIC/TAF/FTC	27 (55.1)	16 (51.6)	11 (61.1)
	DTG/3TC	2 (4.1)	1 (3.2)	1 (5.6)
	DTG/ABC/3TC	5 (10.2)	4 (12.9)	1 (5.6)
	DTG/FTC/TAF/RPV	1 (2.0)	1 (3.2)	0 (0.0)
	DTG/TAF/FTC	12 (24.5)	7 (22.6)	5 (27.8)
	EVG/COB/FTC/TDF	1 (2.0)	1 (3.2)	0 (0.0)
	FTC/TAF/RAL/DRV/r	1 (2.0)	1 (3.2)	0 (0.0)
Regimen 2 (%)
	DOR/3TC/TDF	42 (85.7)	25 (80.6)	17 (94.4)
	DOR/DRV/COBI	2 (4.1)	1 (3.2)	1 (5.6)
	DOR/FTC/TAF	4 (8.2)	4 (12.9)	0 (0.0)
	DRV/COBI/DOR/TDF	1 (2.0)	1 (3.2)	0 (0.0)
Switching from TAF to TDF (%)		35 (71.4)	20 (64.5)	15 (83.3)
Reason for ART switch (%; may be more than 1)
	Weight gain or obesity	41 (83.7)	25 (80.6)	16 (88.9)
	New comorbidity or other intolerance	7 (14.3)	5 (16.1)	2 (11.1)
	Resistance	2 (4.1)	1 (3.2)	1 (5.6)
	Other	4 (8.2)	3 (9.7)	1 (5.6)
BMI 12 months prior to ART switch (mean (SD))		32.6 (7.8)	33.6 (8.3)	30.8 (6.7)
BMI at ART Switch (mean (SD))		33.9 (8.2)	34.7 (9.0)	32.6 (6.8)
BMI category 12 months prior to ART switch (%)
	Healthy	6 (12.2)	2 (6.5)	4 (22.2)
	Overweight	14 (28.6)	9 (29.0)	5 (27.8)
	Obese	29 (59.2)	20 (64.5)	9 (50.0)
BMI category at ART switch (%)
	Healthy	5 (10.2)	2 (6.5)	3 (16.7)
	Overweight	13 (26.5)	9 (29.0)	4 (22.2)
	Obese	31 (63.3)	20 (64.5)	11 (61.1)
Change in weight year prior to ART switch (kg; median [IQR])		2.00 [0.0, 5.0]	1.0 [0.0, 3.5]	3.0 [-1.0, 11.3]
% Change in weight over year prior to ART change (%)
	decrease of 3% or more	5 (10.2)	2 (6.5)	3 (16.7)
	no substantial change in weight	24 (49.0)	20 (64.5)	4 (22.2)
	increase of = > 3% & < 5%	6 (12.2)	2 (6.5)	4 (22.2)
	increase of = > 5% & < 10%	6 (12.2)	4 (12.9)	2 (11.1)
	increase of 10% or more	8 (16.3)	3 (9.7)	5 (27.8)

ART: Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; BIC: Bictegravir; TAF: Tenofovir Alfenamide Fumarate; FTC: Emtricitabine; DTG: Dolutegravir; 3TC: Lamivudine; ABC: Abacavir; RPV: Rilpivirine; EVG: Elvitegravir; COBI: Cobicistat; TDF: Tenofovir Disoproxil Fumatate; RAL: Raltegravir; DRV: Darunavir; r: Ritonavir; BMI: Body Mass Index. Healthy BMI 18.5–24.9, Overweight BMI 25.0–29.9, Obese BMI ≥30.0.

Table A5. Subgroup model results.

Test	Subgroup	% Weight Change 1 Year Post- ART Switch	Difference Between Subgroups at 1 Year
EHR Sex	Male	−2.9% (−4.5%, −1.4%); p: <.001
	Female	−0.6% (−8.6%, 7.4%); p: .87	T-test p-value: .64
Race/Ethnicity	Black/African American, non-Hispanic	1.4% (−6.1%, 8.9%); p: 0.68
	Hispanic, regardless of race	−3.1% (−6.6%, 0.4%); p: .08
	White, non-Hispanic (reference)	3.6% (−6.3%, −0.8%); p: .013	Anova p-value: .21
Year of ART Regimen Switch	2021	−5.3% (−7.7%, −3.0%); p: <.001
	non-2021	−0.6% (−3.6%, 2.3%); p: .66	T-test p-value: .01
Switch from TAF to TDF	TAF to TDF	−0.7% (−3.2%, 1.8%); p: .58
	Other	−6.6% (−9.9%, −3.2%); p: .001	T-test p-value: .01
Weight Change 1 Year Prior to ART Switch	Weight increase of 3% or more	−4.4% (−7.6%, −1.2%); p: .009
	Stable or decreasing weight	−1.0% (−3.8%, 1.9%); p: .49	T-test p-value: .10
CD4 Category at ART Switch	<600 cells/mm^3	0.2% (−3.2%, 3.6%); p: .91
	600 or greater cells/mm^3	−4.6% (−7.1%, −2.2%); p: <.001	T-test p-value: .02
BMI Category At Time of ART Switch	Healthy (BMI 18.5–24.9)	−1.8% (−4.2%, 0.7%); p: .11
	Overweight (BMI 25.0–29.9)	0.6% (−5.0%, 6.3%); p: .81
	Obese (BMI ≥30.0)	−3.7% (−6.2%, −1.3%); p: .004	Anova p-value: .20

EHR: Electronic Health Record; ART: Antiretroviral Therapy; TAF: Tenofovir Alafenamide Fumarate; TDF: Tenofovir Disoproxil Fumarate; BMI: Body Mass Index. BMI Categories: Healthy BMI 18.5–24.9, Overweight BMI 25.0–29.9, Obese BMI ≥30.0.

Table A6. PWH characteristics by TDF to TAF or non-TDF to TAF Switch.

		Overall	TDF to TAF	Not TDF to TAF
n		49	35	14
Age (mean (SD))		47.3 (11.7)	47.3 (11.9)	47.1 (11.4)
Male (%)		37 (75.5)	25 (71.4)	12 (85.7)
Race/Ethnicity (%)
	Black/African American, non-Hispanic	10 (20.4)	7 (20.0)	3 (21.4)
	Hispanic, regardless of race	12 (24.5)	9 (25.7)	3 (21.4)
	Other, non-Hispanic	2 (4.1)	2 (5.7)	0 (0.0)
	White/Caucasian, non-Hispanic	25 (51.0)	17 (48.6)	8 (57.1)
Year of ART switch (%)
	2019	9 (18.4)	7 (20.0)	2 (14.3)
	2020	16 (32.7)	9 (25.7)	7 (50.0)
	2021	18 (36.7)	15 (42.9)	3 (21.4)
	2022	6 (12.2)	4 (11.4)	2 (14.3)
3 or more comorbidity classes (%)		20 (40.8)	13 (37.1)	7 (50.0)
Hypertension (%)		19 (38.8)	12 (34.3)	7 (50.0)
Mental health disorder (%)		17 (34.7)	13 (37.1)	4 (28.6)
Tobacco use (%)		6 (12.2)	4 (11.4)	2 (14.3)
Substance abuse (%)		4 (8.2)	3 (8.6)	1 (7.1)
Diabetes (%)
	Not diabetic	35 (71.4)	27 (77.1)	8 (57.1)
	pre-diabetes	4 (8.2)	2 (5.7)	2 (14.3)
	Type 1 diabetes	1 (2.0)	0 (0.0)	1 (7.1)
	Type 2 diabetes	9 (18.4)	6 (17.1)	3 (21.4)
Hyperlipidemia		9 (18.4)	6 (17.1)	3 (21.4)
Liver disease (%)		7 (14.3)	3 (8.6)	4 (28.6)
Prescription for weight loss medication (%)		11 (22.4)	7 (20.0)	4 (28.6)
Years of HIV (median [IQR])		10.0 [8.0, 19.8]	10.0 [8.0, 21.3]	10.0 [8.0, 15.8]
Years of HIV prior to ART switch (median [IQR])		8.0 [4.0, 18.8]	8.0 [4.0, 20.3]	8.5 [5.3, 12.8]
Viral load at ART switch (%)
	<1000	8 (16.3)	7 (20.0)	1 (7.1)
	> = 1000	3 (6.1)	1 (2.9)	2 (14.3)
	Missing	1 (2.0)	0 (0.0)	1 (7.1)
	Undetectable (<200 copies/mL)	37 (75.5)	27 (77.1)	10 (71.4)
CD4 at ART switch (median [IQR])		608.0 [421.5, 859.8]	608.0 [441.0, 901.0]	646.0 [390.0, 693.0]
Regimen 1 (%)
	BIC/TAF/FTC	27 (55.1)	22 (62.9)	5 (35.7)
	DTG/3TC	2 (4.1)	0 (0.0)	2 (14.3)
	DTG/ABC/3TC	5 (10.2)	0 (0.0)	5 (35.7)
	DTG/FTC/TAF/RPV	1 (2.0)	1 (2.9)	0 (0.0)
	DTG/TAF/FTC	12 (24.5)	11 (31.4)	1 (7.1)
	EVG/COB/FTC/TDF	1 (2.0)	0 (0.0)	1 (7.1)
	FTC/TAF/RAL/DRV/r	1 (2.0)	1 (2.9)	0 (0.0)
Regimen 2 (%)
	DOR/3TC/TDF	42 (85.7)	35 (100.0)	7 (50.0)
	DOR/DRV/COBI	2 (4.1)	0 (0.0)	2 (14.3)
	DOR/FTC/TAF	4 (8.2)	0 (0.0)	4 (28.6)
	DRV/COBI/DOR/TDF	1 (2.0)	0 (0.0)	1 (7.1)
Reason for ART switch (%; may be more than 1)
	Weight gain or obesity	41 (83.7)	30 (85.7)	11 (78.6)
	New comorbidity or other intolerance	7 (14.3)	6 (17.1)	1 (7.1)
	Resistance	2 (4.1)	0 (0.0)	2 (14.3)
	Other	4 (8.2)	3 (8.6)	1 (7.1)
BMI 12 months prior to ART switch (mean (SD))		32.6 (7.8)	33.3 (8.0)	30.8 (7.2)
BMI at ART Switch (mean (SD))		33.91 (8.2)	34.4 (8.5)	32.6 (7.7)
BMI category 12 months prior to ART switch (%)
	Healthy	6 (12.2)	4 (11.4)	2 (14.3)
	Overweight	14 (28.6)	9 (25.7)	5 (35.7)
	Obese	29 (59.2)	22 (62.9)	7 (50.0)
BMI category at ART switch (%)
	Healthy	5 (10.2)	3 (8.6)	2 (14.3)
	Overweight	13 (26.5)	10 (28.6)	3 (21.4)
	Obese	31 (63.3)	22 (62.9)	9 (64.3)
Change in weight year prior to ART switch (kg; median [IQR])		2.0 [0.0, 5.0]	2.0 [-0.5, 6.0]	1.0 [0.0, 4.0]
% Change in weight over year prior to ART change (%)
	decrease of 3% or more	5 (10.2)	5 (14.3)	0 (0.0)
	no substantial change in weight	24 (49.0)	15 (42.9)	9 (64.3)
	increase of = > 3% & < 5%	6 (12.2)	4 (11.4)	2 (14.3)
	increase of = > 5% & < 10%	6 (12.2)	6 (17.1)	0 (0.0)
	increase of 10% or more	8 (16.3)	5 (14.3)	3 (21.4)
		18 (36.7)	15 (42.9)	3 (21.4)

PWH: Persons with HIV; TDF: Tenofovir Disoproxol Fumarate; TAF: Tenofovir Alafenamide Fumarate; ART: Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; BIC: Bictegravir; TAF: Tenofovir Alfenamide Fumarate; FTC: Emtricitabine; DTG: Dolutegravir; 3TC: Lamivudine; ABC: Abacavir; RPV: Rilpivirine; EVG: Elvitegravir; COBI: Cobicistat; TDF: Tenofovir Disoproxil Fumatate; RAL: Raltegravir; DRV: Darunavir; r: Ritonavir; BMI: Body Mass Index; Healthy BMI 18.5–24.9, Overweight BMI 25.0–29.9, Obese BMI ≥30.0.