From the Guidelines
For patients experiencing weight gain while taking Descovy (emtricitabine and tenofovir alafenamide), the most effective management strategy is to implement lifestyle modifications, such as a balanced diet and regular exercise, and monitor weight every 6 months, as recommended by the 2024 guidelines of the International Antiviral Society-USA panel 1. The primary approach to managing weight gain in patients taking Descovy should focus on lifestyle changes, including diet and exercise, especially for those at increased likelihood of weight gain with use of InSTI- and tenofovir alafenamide–based regimens 1. Some key points to consider in managing weight gain in these patients include:
- Regular monitoring of weight and body mass index every 6 months to identify those with excessive weight gain 1
- Emphasis on lifestyle changes, including diet and exercise, to mitigate weight gain 1
- Consideration of the potential benefits and risks of switching to alternative antiretroviral regimens with less impact on weight, although current evidence does not recommend changing regimens solely due to weight gain 1
- Awareness of the potential efficacy of glucagon-like peptide-1 receptor agonists for weight loss among people with HIV, similar to the general population, but also consideration of the potential loss of muscle mass, particularly in older individuals 1 Weight gain with Descovy is generally modest, typically ranging from 2-5 kg, and occurs primarily in the first year of treatment, believed to result from tenofovir alafenamide's lower impact on metabolism compared to older HIV medications 1. Given the most recent and highest quality evidence, lifestyle modifications and regular monitoring are the cornerstone of managing weight gain in patients taking Descovy, with medication adjustments considered on a case-by-case basis, prioritizing both HIV control and metabolic health 1.
From the Research
Weight Gain and Descovy
- Weight gain is a potential issue for patients taking Descovy (emtricitabine and tenofovir alafenamide) 2, 3.
- A study found that participants taking tenofovir alafenamide, emtricitabine, and dolutegravir had a mean weight gain of 7.1 kg, which was greater than the weight gain in the other treatment groups 2.
- Another study found that participants taking emtricitabine and tenofovir alafenamide had a median weight gain of 1.7 kg, compared to 0.5 kg for those taking emtricitabine and tenofovir disoproxil fumarate 3.
- The mechanism of weight gain associated with Descovy is not fully understood, but it may be related to the improvement in immune function and the reduction in inflammation 2, 3.
Managing Weight Gain
- There are no specific recommendations for managing weight gain in patients taking Descovy, but general strategies for weight management may be helpful, such as:
- Healthy diet
- Regular exercise
- Monitoring weight and body mass index (BMI)
- Healthcare providers should monitor patients taking Descovy for weight gain and provide guidance on healthy lifestyle habits 2, 3.
Comparison to Other Treatments
- Descovy has been compared to other treatments, such as emtricitabine and tenofovir disoproxil fumarate, in terms of weight gain and other safety outcomes 2, 4, 3.
- The results of these studies suggest that Descovy may have a more favorable safety profile, including less weight gain, compared to some other treatments 4, 3.