Weight gain risk for people taking dolutegravir-based ARVs

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People taking dolutegravir-based antiretroviral treatment have a substantially higher risk of becoming overweight or obese compared to other people with HIV and almost one in ten put on enough weight to be classified as overweight or obese, Aidsmap reports a prospective study in four African countries has shown.

The findings were presented at the 23rd International AIDS Conference (AIDS 2020: Virtual) by Dr Julie Ake of the US Military HIV Research Programme at Walter Reed Army Institute of Research.

A study of adolescents switching to dolutegravir from another antiretroviral regimen in Eswatini also showed greater odds of weight gain as time on the drug increased, but researchers cautioned that more research is needed with adolescents with HIV before drawing conclusions.

Adolescents form a growing proportion of those receiving antiretroviral treatment in sub-Saharan Africa but there has been no information about weight patterns after starting antiretroviral treatment.

Weight gain was observed in a cohort of 605 adolescents aged 10-19 switching to dolutegravir at the Baylor Childrens Foundation clinic in Mbabane, Eswatini. All had been in care for at least a year and had suppressed viral load (< 200 copies/ml).

The cohort was evenly balanced between male and female patients. Thirty per cent were aged 10-12 years, 46% aged 13-16 years and 24% 17-19 years. The majority were switching from nevirapine (73%) and the remainder from efavirenz (27%).

Tenofovir/lamivudine was used as the backbone with dolutegravir by 88% of participants; the remainder used abacavir/lamivudine (12%).

After switching to dolutegravir, boys gained an average of 0.64kg/m2 in body mass per year and girls gained an average of 0.55kg/m2. Adjusting for other covariates, adolescents taking tenofovir/lamivudine/dolutegravir had a BMI 0.660 kg/m2 higher, on average, than those taking abacavir/lamivudine/dolutegravir (p < 0.001). Females had a BMI 1.371 kg/m2 higher, on average, than males (p < 0.001).

After switching to dolutegravir the odds of becoming overweight or obese increased by approximately 1% every day. This rate of increase was largely explained by greater body mass index change in adolescents who were categorised as thin prior to dolutegravir initiation. In the light of this finding, the increased risk of becoming overweight in adolescents needs to be interpreted cautiously, the investigators say. Further research is needed on risk factors for becoming overweight or obese after starting dolutegravir in adolescents.

Abstracts (not available online)
Ake, J et al: Weight gain and hyperglycemia during the dolutegravir transition in Africa. 23rd International AIDS Conference, abstract 3328, 2020.
Kay, A et al: Optimization to dolutegravir-based ART in a cohort of virally suppressed adolescents is associated with an increase in the rate of BMI change and odds of becoming overweight. 23rd International AIDS Conference, abstract 8794, 2020.

Full Aidsmap report

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