Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa

Brennan, Alana T.; Nattey, Cornelius; Kileel, Emma M.; Rosen, Sydney; Maskew, Mhairi; Stokes, Andrew; Fox, Matthew P.; Venter, W D Francois

doi:10.1016/j.eclinm.2023.101836

Cited by 55 publications

(31 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Larger studies with more power are needed to detect small differences in changes in adherence or VL, although such small effects may have limited clinical relevance. Consistent with the literature, weight gain on TLD in our study was more common among participants of female sex [4,5,[7][8][9][10] and participants switching from efavirenz, possibly related to its weight-suppressive effect [6]. A TBW gain ≥5% was more common among participants who were underweight before switching to TLD and suggestive of a 'return to health' effect for them; however, the combined prevalence of overweight and obesity increased from 32.6% to 37.7% after switching to TLD supporting an increase in excess weight gain.…”

Section: Discussionsupporting

confidence: 92%

“…In sub-Saharan African countries, tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) has replaced first-line regimens containing efavirenz and is positively impacting HIV treatment outcomes because of improved tolerability, high antiviral potency and a high genetic barrier to drug resistance [2,3]. However, randomized trials have found that dolutegravir is associated with greater weight gain than efavirenz [4][5][6] and observational studies have demonstrated varying magnitudes of weight gain in different populations during the TLD transition in sub-Saharan Africa [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of weight gain with dolutegravir on antiretroviral adherence and viral suppression in four African countries

et al. 2023

View full text Add to dashboard Cite

ObjectiveWe hypothesized that total body weight (TBW) gain after switching antiretroviral therapy (ART) regimen to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) may negatively impact ART adherence and viral load (VL) and therefore sought to examine these associations.MethodsThe ongoing African Cohort Study (AFRICOS) enrols people with HIV at 12 facilities in Kenya, Nigeria, Tanzania and Uganda supported by The US President's Emergency Plan for AIDS Relief. Among ART‐experienced participants who switched to TLD, we used multivariable multinomial logistic regression to examine associations between pre−/post‐TLD changes in percentage TBW (≥5% gain, <5% change, ≥5% loss) and changes in self‐reported ART adherence (0, 1–2, ≥3 days missed doses in past 30 days) and VL [(<50 copies/mL (undetectable), 50–999 copies/mL (detectable, but suppressed), ≥1000 copies/mL (unsuppressed)].ResultsAmong 1508 participants, median time from starting TLD to follow‐up was 9 months (interquartile range: 7–11). Overall, 438 (29.1%) participants experienced a TBW gain ≥5%, which was more common among females than among males (32.2% vs 25.2%, p = 0.005) and participants switching from efavirenz [32.0% vs nevirapine (19.9%) and boosted protease inhibitor (20.0%); p < 0.001]. Compared with a TBW change <5% [950 (63.0%) participants], TBW gain ≥5% was not significantly associated with more days with missed ART doses [adjusted odds ratio (aOR) = 0.77, 95% confidence interval (CI): 0.48–1.23] or VL becoming detectable and/or unsuppressed (aOR = 0.69, 95% CI: 0.41–1.16).ConclusionsAlthough a substantial proportion of participants experienced weight gain after switching to TLD, we did not identify a significant impact on adherence or virological outcomes.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Impact of weight gain with dolutegravir on antiretroviral adherence and viral suppression in four African countries

et al. 2023

View full text Add to dashboard Cite

show abstract

“…In the Johannesburg cohort [26 ▪▪ ], 794 people with undetectable HIV RNA levels switching from efavirenz to dolutegravir were matched to 794 controls who remained on efavirenz-based treatment. After 48 weeks of follow up, Grade 1 hypertension was observed for 25% of those switching to dolutegravir versus 11% those remaining on efavirenz ( P < 0.001), but with a higher change in mean weight for the people who switched to dolutegravir (+1.8 kg).…”

Section: Results From Observational Studiesmentioning

confidence: 99%

Clinical consequences of weight gain during treatment for HIV infection

Hill,

Venter

2023

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

Purpose of review The introduction of dolutegravir, an oral integrase inhibitor, within public health HIV programs has been a success, with excellent sustained viral load suppression, persistence, and safety. Initial concerns around integrase-inhibitors being implicated in safety concerns around immune reconstitution inflammatory syndromes (IRIS), neural tube defects, and weight gain, have been largely laid to rest, but new concerns about cardiovascular risk have arisen, including a link between hypertension and this antiretroviral class. Recent findings We review the pertinent studies here, and while we find both observational and randomized controlled study associations in some but not all studies, these are often confounded by associated weight gain and aging. In addition, definitions of hypertension, as well as measurement within the studies (such as cuff size), were not consistent within studies. Summary Careful analysis will be needed, as with the weight-gain signal, before assigning causation, especially as plausible physiological mechanisms for this rise in blood pressure are unclear.

show abstract

“…Several studies found an association between INSTI-based ART and weight gain [3][4][5][6][7][8][9]. DTG was associated with greater weight gain than other antiretroviral classes and older INSTIs like raltegravir [6].…”

Section: Introductionmentioning

confidence: 99%

Body weight and blood pressure changes on dolutegravir‐, efavirenz‐ or atazanavir‐based antiretroviral therapy in Zimbabwe: a longitudinal study

Shamu,

Egger,

Mudzviti

et al. 2024

J Int AIDS Soc.

View full text Add to dashboard Cite

IntroductionDolutegravir (DTG) is widely used for antiretroviral therapy (ART). We compared weight and blood pressure trends and examined the association between high blood pressure and weight gain among people living with HIV (PLHIV) switching to or starting DTG‐based, efavirenz (EFV)‐based and ritonavir‐boosted atazanavir (ATV/r)‐based ART in Zimbabwe.MethodsPLHIV aged 18 years or older who started or switched to DTG, EFV or ATV/r‐based ART between January 2004 and June 2022 at Newlands Clinic in Harare, Zimbabwe, were eligible. Weight was measured at all visits (Seca floor scales); blood pressure only at clinician‐led visits (Omron M2 sphygmomanometer). We used Bayesian additive models to estimate trends in weight gain and the proportion with high blood pressure (systolic >140 mmHg or diastolic >90 mmHg) in the first 2 years after starting or switching the regimen. Finally, we examined whether trends in the proportion with high blood pressure were related to weight change.ResultsWe analysed 99,969 weight and 35,449 blood pressure records from 9487 adults (DTG: 4593; EFV: 3599; ATV/r: 1295). At 24 months after starting or switching to DTG, estimated median weight gains were 4.54 kg (90% credibility interval 3.88−5.28 kg) in women and 3.71 kg (3.07−4.45 kg) in men, around twice that observed for ATV/r and over four‐times the gain observed for EFV. Prevalence of high blood pressure among PLHIV receiving DTG‐based ART increased from around 5% at baseline to over 20% at 24 months, with no change in PLHIV receiving EFV‐ or ATV/r‐based ART. High blood pressure in PLHIV switching to DTG was associated with weight gain, with stronger increases in the proportion with high blood pressure for larger weight gains.ConclusionsAmong PLHIV starting ART or switching to a new regimen, DTG‐based ART was associated with larger weight gains and a substantial increase in the prevalence of high blood pressure. Routine weight and blood pressure measurement and interventions to lower blood pressure could benefit PLHIV on DTG‐based ART. Further studies are needed to elucidate the mechanisms and reversibility of these changes after discontinuation of DTG.

show abstract

Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa

Cited by 55 publications

References 30 publications

Impact of weight gain with dolutegravir on antiretroviral adherence and viral suppression in four African countries

Impact of weight gain with dolutegravir on antiretroviral adherence and viral suppression in four African countries

Clinical consequences of weight gain during treatment for HIV infection

Body weight and blood pressure changes on dolutegravir‐, efavirenz‐ or atazanavir‐based antiretroviral therapy in Zimbabwe: a longitudinal study

Contact Info

Product

Resources

About